MEDICARE: ASHLEY MEGAN GAGNON DMD, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	17634	GA
2	122300000X	Dentist	DN123028	GA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1255072583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MEGAN GAGNON DMD, MD

Provider Business Mailing Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1059
Country	:	US
Telephone Number	:	404-712-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-778-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2022
Last Update Date	:	01/19/2026

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