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NPI Code Detail

MEDICARE: MRS. MEGAN W WALPOLE PAC

MEDICARE: MRS. MEGAN W WALPOLE PAC
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
1363AM0700XMedical Physician Assistant308663LA

General Provider Information

NPI Number : 1841439387
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MEGAN W WALPOLE PAC
Provider Business Mailing Address
First Line : 131 CREEKSIDE DR
Second Line :
City : RUSTON
State : LA
Zip : 71270-1766
Country : US
Telephone Number : 404-680-0415
Fax Number :
Provider Business Practice Location Address
First Line : 6325 SHANNON PKWY
Second Line : SUITE D
City : UNION CITY
State : GA
Zip : 30291-1538
Country : US
Telephone Number : 770-964-1400
Fax Number : 770-306-1343
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2009
Last Update Date : 04/20/2021

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Directions to “ MRS. MEGAN W WALPOLE PAC” Practice Location

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