MEDICARE: MEREDITH MORGAN CONNOR LCSW

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	1041C0700X	Clinical Social Worker	004390	GA

General Provider Information

NPI Number	:	1487950804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH MORGAN CONNOR LCSW

Provider Business Mailing Address
First Line	:	6645 PEACHTREE DUNWOODY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-1606
Country	:	US
Telephone Number	:	770-455-7111
Fax Number	:	770-455-7118

Provider Business Practice Location Address
First Line	:	6645 PEACHTREE DUNWOODY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-1606
Country	:	US
Telephone Number	:	770-455-7111
Fax Number	:	770-455-7118

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

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	08/30/2012

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