Healthcare Provider Details

I. General information

NPI: 1558858589
Provider Name (Legal Business Name): MEGAN DIBBERN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-0816
US

IV. Provider business mailing address

1364 CLIFTON RD NE RM H-188
ATLANTA GA
30322-1059
US

V. Phone/Fax

Practice location:
  • Phone: 434-982-1018
  • Fax: 434-924-9492
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number101483
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number101483
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: