Provider Demographics
NPI:1881251668
Name:MEEHAN, MICHAEL ANTHONY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:MEEHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMPREHENSIVE PRIMARY CARE, LLC
Mailing Address - Street 2:3905 JOHNS CREEK CT, SUITE 200
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-888-2273
Mailing Address - Fax:678-888-2200
Practice Address - Street 1:COMPREHENSIVE PRIMARY CARE, LLC
Practice Address - Street 2:761 WALTHER RD , SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:678-888-2273
Practice Address - Fax:678-888-2200
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101279207R00000X
SC88694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty