Provider Demographics
NPI:1164907242
Name:SKELLEY, MEGAN (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SKELLEY
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 ROCK SPRINGS CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2328
Mailing Address - Country:US
Mailing Address - Phone:678-977-7387
Mailing Address - Fax:
Practice Address - Street 1:487 WINN WAY STE 202
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1728
Practice Address - Country:US
Practice Address - Phone:404-294-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216471363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner