Provider Demographics
NPI:1679322432
Name:STALVEY, MEGAN A
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:STALVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:S
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1665 CARPENTER RD S APT A6
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7974
Mailing Address - Country:US
Mailing Address - Phone:229-402-6271
Mailing Address - Fax:
Practice Address - Street 1:620 VIRGINIA AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4227
Practice Address - Country:US
Practice Address - Phone:229-386-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist