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General NPI Number Information
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NPI Number | 1942802517
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Entity Type | Individual
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Provider Name | MEGAN LUEDTKE PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1364 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1059
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Country | US
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Telephone | 404-778-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 300 FAVOR RD APT 2310
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7682
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Country | US
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Telephone | 708-846-5459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12803
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License Number State | GA
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