Provider Demographics
NPI:1740065366
Name:MCKAY, MEAGAN JANE
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:JANE
Last Name:MCKAY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:JANE
Other - Last Name:MCKAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25103 PLANTATION DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-2945
Mailing Address - Country:US
Mailing Address - Phone:425-614-9676
Mailing Address - Fax:
Practice Address - Street 1:115 CHERRY ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7205
Practice Address - Country:US
Practice Address - Phone:770-793-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA12924363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program