Healthcare Provider Details

I. General information

NPI: 1992137475
Provider Name (Legal Business Name): MEGAN LOUISE FENCEROY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PARKWAY N
NEWNAN GA
30265-8000
US

IV. Provider business mailing address

600 PARKWAY N
NEWNAN GA
30265-8000
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-7186
  • Fax:
Mailing address:
  • Phone: 770-400-7186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number207428
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: