Provider Demographics
NPI:1588456313
Name:MATHIS, MEGAN (APC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 GARDENSIDE CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-2700
Mailing Address - Country:US
Mailing Address - Phone:770-861-4304
Mailing Address - Fax:
Practice Address - Street 1:1342 GLENWOOD AVE SE STE 2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2048
Practice Address - Country:US
Practice Address - Phone:404-492-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health