MEDICARE: MEGAN GRACE GREESON

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1164251732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN GRACE GREESON

Provider Business Mailing Address
First Line	:	2211 CASH RD SE
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-4215
Country	:	US
Telephone Number	:	706-879-9460
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 CENTRAL PLZ # 101
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-3230
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	07/31/2024

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Directions to “ MEGAN GRACE GREESON ” Practice Location

Language	Start Address	Practice Location

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