Provider Demographics
NPI:1477813954
Name:MCGOWAN, MONICA TRECHELE (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:TRECHELE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3464 VILLAGE PARK LANE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331
Mailing Address - Country:US
Mailing Address - Phone:404-374-5849
Mailing Address - Fax:
Practice Address - Street 1:2550 WINDY HILL RD SE
Practice Address - Street 2:SUITE 215
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8665
Practice Address - Country:US
Practice Address - Phone:770-850-9727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR149268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128580GMedicaid
GA003128580FMedicaid
GA003128580HMedicaid
GA003128580DMedicaid
GA003128580EMedicaid
GA003128580JMedicaid
GA003128580AMedicaid
GA003128580FMedicaid