Healthcare Provider Details

I. General information

NPI: 1891240941
Provider Name (Legal Business Name): COLLEEN MARGARET MEFFERT CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 PEACHTREE DUNWOODY RD STE B110
ATLANTA GA
30328-5911
US

IV. Provider business mailing address

531 ROSELANE ST NW STE 830
MARIETTA GA
30060-6979
US

V. Phone/Fax

Practice location:
  • Phone: 470-308-4905
  • Fax:
Mailing address:
  • Phone: 770-794-0477
  • Fax: 770-794-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number1000-00671
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: