Basic Information
| Provider Information | |||||||||
| NPI: | 1144412883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWEET | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | CHRISTINA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7876 KIVERTON PL | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303505890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433703976 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5670 PEACHTREE DUNWOODY RD NE | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042551930 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2007 | ||||||||
| LastUpdateDate: | 05/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-01000 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 006803 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 202019 | 01 | MEDCOST | OTHER | 9608073 | 01 | AETNA | OTHER | P00416752 | 01 | RR MEDICARE | OTHER |