MEDICARE: MEAGAN KATHLEEN O'BRIEN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9111223	FL
2	363A00000X	Physician Assistant	9708	GA
3	363A00000X	Physician Assistant	10002724A	IN
4	363A00000X	Physician Assistant	085005839	IL
5	363A00000X	Physician Assistant	PA12878	TX

General Provider Information

NPI Number	:	1114379732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN KATHLEEN O'BRIEN PA

Provider Business Mailing Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5673 PEACHTREE DUNWOODY RD STE 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2147
Country	:	US
Telephone Number	:	855-366-7989
Fax Number	:	404-251-2973

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	01/20/2022

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Directions to “ MEAGAN KATHLEEN O'BRIEN PA” Practice Location

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