Provider Demographics
NPI:1912121302
Name:PETERS, MEGHAN ELIZABETH (MD, PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-500-2144
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:11021 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865
Practice Address - Country:US
Practice Address - Phone:865-579-3720
Practice Address - Fax:865-577-7309
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17712183500000X
TN51682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007766Medicaid