Provider Demographics
NPI:1134460637
Name:OSBORNE, MEGAN L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:L
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:478-745-6130
Mailing Address - Fax:478-745-4443
Practice Address - Street 1:308 COLISEUM DR STE 120
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3859
Practice Address - Country:US
Practice Address - Phone:478-745-6130
Practice Address - Fax:478-745-4443
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA006751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003132087BMedicaid
GA003132087AMedicaid
GA003132087AMedicaid