Provider Demographics
NPI:1700319969
Name:SMITH, MEAGAN NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:NICOLE
Other - Last Name:ISHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 21007
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35813-5007
Mailing Address - Country:US
Mailing Address - Phone:568-016-0482
Mailing Address - Fax:
Practice Address - Street 1:13596 HWY 231 431 STE 2
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35813-5007
Practice Address - Country:US
Practice Address - Phone:256-428-4950
Practice Address - Fax:256-828-0526
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics