Provider Demographics
NPI:1104024496
Name:KELLEHER, MEREDITH PAGE (MMSC, PA-C)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:PAGE
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:MMSC, PA-C
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:PAGE
Other - Last Name:CADORETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1737 STONEY CREEK DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3675
Mailing Address - Country:US
Mailing Address - Phone:404-831-5783
Mailing Address - Fax:
Practice Address - Street 1:5669 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 170
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1786
Practice Address - Country:US
Practice Address - Phone:404-252-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04752363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical