Healthcare Provider Details

I. General information

NPI: 1558084822
Provider Name (Legal Business Name): MEGAN RAE AMAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 CLIFTON RD NE
ATLANTA GA
30322-4201
US

IV. Provider business mailing address

1520 CLIFTON RD NE
ATLANTA GA
30322-4201
US

V. Phone/Fax

Practice location:
  • Phone: 47-277-9804
  • Fax:
Mailing address:
  • Phone: 404-727-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number306011
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN306011
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN306011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: