Healthcare Provider Details

I. General information

NPI: 1376755538
Provider Name (Legal Business Name): PAUL L MEFFERD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CHURCH ST NE STE 520
MARIETTA GA
30060-7282
US

IV. Provider business mailing address

790 CHURCH ST NE STE 520
MARIETTA GA
30060-7282
US

V. Phone/Fax

Practice location:
  • Phone: 770-419-9902
  • Fax: 770-419-7457
Mailing address:
  • Phone: 770-419-9902
  • Fax: 770-419-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number054617
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number54617
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: