Healthcare Provider Details

I. General information

NPI: 1548318983
Provider Name (Legal Business Name): AUDREY R MEYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 HARPER ST STE 4E
AUGUSTA GA
30912-0020
US

IV. Provider business mailing address

1447 HARPER ST STE 4E
AUGUSTA GA
30912-0020
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4581
  • Fax: 706-721-1962
Mailing address:
  • Phone: 706-721-4581
  • Fax: 706-721-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13065
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.003238
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: