Healthcare Provider Details

I. General information

NPI: 1275965634
Provider Name (Legal Business Name): MEGAN MICHELLE DONALD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN MICHELLE HANSE

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 HIGHWAY 34 E STE 3000
NEWNAN GA
30265-6430
US

IV. Provider business mailing address

101 YORKTOWN DR SUITE 110
FAYETTEVILLE GA
30214-1578
US

V. Phone/Fax

Practice location:
  • Phone: 770-252-6767
  • Fax:
Mailing address:
  • Phone: 678-364-5400
  • Fax: 678-364-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN198740
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN198740
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: