Provider Demographics
NPI:1235516303
Name:STAUCH, MEREDITH (NP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:STAUCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:ASHOOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:NORTHSIDE HOSPITAL - MANAGED CARE DEPT
Mailing Address - Street 2:1000 JOHNSON FERRY RD NE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-300-2476
Mailing Address - Fax:404-250-8010
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 150A
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4357
Practice Address - Country:US
Practice Address - Phone:770-509-1025
Practice Address - Fax:770-509-1884
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN232705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily