Provider Demographics
NPI:1003469677
Name:SMITH, MEGAN IRENE (NP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:IRENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:IRENE
Other - Last Name:BUELTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 240
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6017
Mailing Address - Country:US
Mailing Address - Phone:770-844-0877
Mailing Address - Fax:770-844-0891
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 240
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6017
Practice Address - Country:US
Practice Address - Phone:770-844-0877
Practice Address - Fax:770-844-0891
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN273431363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner