Meagan Elise McKinnon, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

008711 Issued in GA

Practice address

4 Live Oak CT
Moultrie, GA 31768-6783

Phone

(229) 785-2400

Fax

(229) 502-9793

NPI assigned

Sep 14, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Surgical Professional Services LLCGroup PAC ID 8628253424, 367 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  Medicare reassignment Care Compare group
• Advanced Joint Surgery Specialists, LLC

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1477929206
  Medicare reassignment
• Cooperative Healthcare Services Inc

  • Clinic/Center
  • Brunswick, GA
  • NPI 1417979402
  Medicare reassignment
• Kidney Care Center of Georgia LLC

  • Nephrology Physician
  • Gainesville, GA
  • NPI 1588981187
  Medicare reassignment
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1013313857
  Medicare reassignment
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1356907273
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1285916437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2876",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317762876",
            "telephone_number": "229-891-9131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 LIVE OAK CT",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686783",
            "telephone_number": "229-785-2400",
            "fax_number": "229-502-9793"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3131 S Main St",
            "address_purpose": "LOCATION",
            "city": "Moultrie",
            "state": "GA",
            "postal_code": "317686925",
            "country_code": "US",
            "telephone_number": "229-785-2400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16 Live Oak Ct",
            "address_purpose": "LOCATION",
            "city": "Moultrie",
            "state": "GA",
            "postal_code": "31768",
            "country_code": "US",
            "telephone_number": "229-785-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKINNON",
        "first_name": "MEAGAN",
        "middle_name": "ELISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-14",
        "last_updated": "2023-08-01",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "008711",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "AT001938",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "008711",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Misty Leigh McGough, FNP
• Dale McGregor, D.O.
• Montavious T McKenzie
• McKinney Therapy LLC
• Maresa McKinney, LPC
• Benjamin L McLeod, NP
• Christopher Neil Medders, NP
• Medical Diagnostics Inc.
• Medical Specialty Associates, Inc.
• Carol Asfoura Medina, MD

• Medical Physician Assistant in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.