Healthcare Provider Details

I. General information

NPI: 1023814092
Provider Name (Legal Business Name): MEREDITH CHURCHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 OLD PEACHTREE RD APT 4218
DULUTH GA
30097-5325
US

IV. Provider business mailing address

1290 OLD PEACHTREE RD APT 4218
DULUTH GA
30097-5325
US

V. Phone/Fax

Practice location:
  • Phone: 404-938-3289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number171425
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: