Healthcare Provider Details

I. General information

NPI: 1235516303
Provider Name (Legal Business Name): MEREDITH STAUCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH ASHOOH NP

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 OLDE TOWNE PKWY STE 150A
MARIETTA GA
30068-4357
US

IV. Provider business mailing address

NORTHSIDE HOSPITAL - MANAGED CARE DEPT 1000 JOHNSON FERRY RD NE
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 770-509-1025
  • Fax: 770-509-1884
Mailing address:
  • Phone: 404-300-2476
  • Fax: 404-250-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN232705
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: