Provider Demographics
NPI:1326400995
Name:MEGALLY, NADA
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:MEGALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10692 MEDLOCK BRIDGE RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8497
Mailing Address - Country:US
Mailing Address - Phone:404-446-2492
Mailing Address - Fax:404-446-2497
Practice Address - Street 1:10692 MEDLOCK BRIDGE RD STE 100A
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-8497
Practice Address - Country:US
Practice Address - Phone:404-446-2496
Practice Address - Fax:404-446-2497
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA86089207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1669784252OtherNPI