Provider Demographics
NPI:1801527056
Name:MEADOWS, ALEXXUS KERRY
Entity type:Individual
Prefix:
First Name:ALEXXUS
Middle Name:KERRY
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 HIDDEN LAKE CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1667
Mailing Address - Country:US
Mailing Address - Phone:608-588-5170
Mailing Address - Fax:
Practice Address - Street 1:92 HIDDEN LAKE CT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1667
Practice Address - Country:US
Practice Address - Phone:608-588-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22-220957106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician