MEDICARE: MEAGAN SHIPES

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	101YM0800X	Mental Health Counselor	APC009655	GA

General Provider Information

NPI Number	:	1316772650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN SHIPES

Provider Business Mailing Address
First Line	:	7500 ROSWELL RD UNIT 40
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-4834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 ROSWELL RD STE 38
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-8829
Country	:	US
Telephone Number	:	470-219-8775
Fax Number	:

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

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	09/05/2024

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Directions to “ MEAGAN SHIPES ” Practice Location

Language	Start Address	Practice Location

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