Healthcare Provider Details

I. General information

NPI: 1003469677
Provider Name (Legal Business Name): MEGAN IRENE SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN IRENE BUELTEL NP

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHSIDE FORSYTH DR STE 240
CUMMING GA
30041-6017
US

IV. Provider business mailing address

1400 NORTHSIDE FORSYTH DR STE 240
CUMMING GA
30041-6017
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-0877
  • Fax: 770-844-0891
Mailing address:
  • Phone: 770-844-0877
  • Fax: 770-844-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN273431
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: