Provider Demographics
NPI:1568929073
Name:CROAK, MEGHAN KATHERINE (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:KATHERINE
Last Name:CROAK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 FORREST WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3716
Mailing Address - Country:US
Mailing Address - Phone:404-906-0151
Mailing Address - Fax:
Practice Address - Street 1:41 PERIMETER CTR E STE 250
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30346-1902
Practice Address - Country:US
Practice Address - Phone:609-902-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245262363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health