Provider Demographics
NPI:1184216442
Name:GAINES, MEGAN RUTH (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RUTH
Last Name:GAINES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6736
Mailing Address - Country:US
Mailing Address - Phone:912-644-5333
Mailing Address - Fax:912-644-5280
Practice Address - Street 1:210 E DERENNE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6736
Practice Address - Country:US
Practice Address - Phone:912-644-5333
Practice Address - Fax:912-644-5280
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA9772363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant