Provider Demographics
NPI:1659446979
Name:SMITH, MEGAN KATE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:KATE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SAGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30683-1563
Mailing Address - Country:US
Mailing Address - Phone:706-742-5758
Mailing Address - Fax:603-843-2144
Practice Address - Street 1:150 SAGEWOOD DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30683-1563
Practice Address - Country:US
Practice Address - Phone:706-742-5758
Practice Address - Fax:603-843-2144
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10040251OtherAMERIGROUP PROVIDER NUM
GA322000OtherWELLCARE POVIDER NUMBER