Provider Demographics
NPI:1841328101
Name:STATON, MEREDITH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:
Last Name:STATON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3320 OLD JEFFERSON RD BLDG 800
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1400
Mailing Address - Country:US
Mailing Address - Phone:706-353-2990
Mailing Address - Fax:706-353-2992
Practice Address - Street 1:355 CLEAR CREEK PKWY STE 2007
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-4271
Practice Address - Country:US
Practice Address - Phone:706-356-2934
Practice Address - Fax:706-356-8037
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003412363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003412OtherSTATE LISENCE
GA003412OtherSTATE LISENCE