Provider Demographics
NPI:1255531059
Name:JUNEAU, MERYL DICKERSON (RNFA)
Entity type:Individual
Prefix:MS
First Name:MERYL
Middle Name:DICKERSON
Last Name:JUNEAU
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3316 PINE HEIGHTS DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-2844
Mailing Address - Country:US
Mailing Address - Phone:404-239-0161
Mailing Address - Fax:
Practice Address - Street 1:3316 PINE HEIGHTS DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-2844
Practice Address - Country:US
Practice Address - Phone:404-239-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical