Provider Demographics
NPI:1558455683
Name:MEEHAN, PETER L (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:L
Last Name:MEEHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:LEO
Other - Last Name:MEEHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6 EXECUTIVE PARK DR NE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2221
Mailing Address - Country:US
Mailing Address - Phone:404-321-9900
Mailing Address - Fax:404-321-4460
Practice Address - Street 1:6 EXECUTIVE PARK DR NE
Practice Address - Street 2:SUITE 10
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2221
Practice Address - Country:US
Practice Address - Phone:404-321-9900
Practice Address - Fax:404-321-4460
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013911207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00119578EMedicaid
D40634Medicare UPIN
GA00119578EMedicaid