Healthcare Provider Details

I. General information

NPI: 1730704636
Provider Name (Legal Business Name): MEGAN GABRIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 JEFFERSON STREET
NEWNAN GA
30263
US

IV. Provider business mailing address

1415 HIGHWAY 70
NEWNAN GA
30263-4720
US

V. Phone/Fax

Practice location:
  • Phone: 877-288-4760
  • Fax:
Mailing address:
  • Phone: 770-283-7961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44457
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-122954
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: