Healthcare Provider Details

I. General information

NPI: 1194345264
Provider Name (Legal Business Name): MEGHAN MCHALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2020
Last Update Date: 06/18/2022
Certification Date: 06/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 BOULEVARD NE
ATLANTA GA
30312-1468
US

IV. Provider business mailing address

3442 N DRUID HILLS RD APT H
DECATUR GA
30033-3707
US

V. Phone/Fax

Practice location:
  • Phone: 404-658-1500
  • Fax:
Mailing address:
  • Phone: 315-256-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN262222
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN262222
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: