Provider Demographics
NPI:1881140598
Name:WILSON, MEAGAN (NP-C)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:CLASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6002 HIGHWAY 53 E STE 100
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6227
Mailing Address - Country:US
Mailing Address - Phone:706-265-8002
Mailing Address - Fax:706-429-0033
Practice Address - Street 1:6002 GA 53
Practice Address - Street 2:SUITE 100
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534
Practice Address - Country:US
Practice Address - Phone:706-265-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215371363LF0000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily