Healthcare Provider Details

I. General information

NPI: 1740065366
Provider Name (Legal Business Name): MEAGAN MCKAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGGIE JANE MCKAY

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CHERRY ST NE
MARIETTA GA
30060-7205
US

IV. Provider business mailing address

25103 PLANTATION DR NE
ATLANTA GA
30324-2945
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-5700
  • Fax:
Mailing address:
  • Phone: 425-614-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12924
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: