Individual
MEAGAN ELISE MCKINNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4 LIVE OAK CT, MOULTRIE, GA 31768-6783
(229) 785-2400
(229) 502-9793
Mailing address
PO BOX 2876, MOULTRIE, GA 31776-2876
(229) 891-9131
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
AT001938
GA
363AM0700X
Medical Physician Assistant
Primary
008711
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008711
LICENSE
GA
Enumeration date
09/14/2011
Last updated
08/01/2023
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