Healthcare Provider Details

I. General information

NPI: 1801133228
Provider Name (Legal Business Name): MEREDITH A SCHANDA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 GRIFFIN AVE
VALDOSTA GA
31601-6331
US

IV. Provider business mailing address

520 GRIFFIN AVE
VALDOSTA GA
31601-6331
US

V. Phone/Fax

Practice location:
  • Phone: 229-245-0020
  • Fax:
Mailing address:
  • Phone: 229-245-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2277966
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2277966
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2277966
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN256258
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2277966
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: