Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1981 | AL |
Y | 213ES0000X | Sports Medicine | 1981 | AL |
NPI | 1275043895 |
---|---|
Provider Name | Michaela Grace Meadows |
First Address | Jacksonville, AL 36265-1602 |
Second Address | Jacksonville, AL 36265-1602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2017 |
Last Update Date | 10/10/2017 |