MEDICARE: MEGHAN CLARK M.S.

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	235Z00000X	Speech-Language Pathologist	SLP012535	GA

General Provider Information

NPI Number	:	1730876236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN CLARK M.S.

Provider Business Mailing Address
First Line	:	4080 MCGINNIS FERRY RD STE 701
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3950
Country	:	US
Telephone Number	:	770-410-7719
Fax Number	:	770-410-9510

Provider Business Practice Location Address
First Line	:	3378 LAVISTA ROAD
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084
Country	:	US
Telephone Number	:	404-838-7333
Fax Number	:

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

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	01/14/2026

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Directions to “ MEGHAN CLARK M.S.” Practice Location

Language	Start Address	Practice Location

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