Provider Demographics
NPI:1972076537
Name:STIDHAM, MEREDITH C (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:C
Last Name:STIDHAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:C
Other - Last Name:KIEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 PEACHTREE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1804
Mailing Address - Country:US
Mailing Address - Phone:404-522-6330
Mailing Address - Fax:
Practice Address - Street 1:133 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1804
Practice Address - Country:US
Practice Address - Phone:404-522-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017809363LF0000X
GARN291114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily