Healthcare Provider Details

I. General information

NPI: 1558455683
Provider Name (Legal Business Name): PETER L MEEHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PETER LEO MEEHAN

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 TREE LN
SNELLVILLE GA
30078-6782
US

IV. Provider business mailing address

1700 TREE LN STE 300
SNELLVILLE GA
30078-6747
US

V. Phone/Fax

Practice location:
  • Phone: 678-205-4299
  • Fax: 678-214-6112
Mailing address:
  • Phone: 678-205-4299
  • Fax: 678-214-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number013911
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: