Healthcare Provider Details

I. General information

NPI: 1235856899
Provider Name (Legal Business Name): MEGAN CAUDELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 N DECATUR RD STE 512
DECATUR GA
30033-6134
US

IV. Provider business mailing address

5527 SALUDA WAY NW
ACWORTH GA
30101-8073
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-2930
  • Fax:
Mailing address:
  • Phone: 770-881-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number11314
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: