Provider Demographics
NPI:1538554522
Name:MEEKS, NATALIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:MEEKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:WALCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1180 RESURGENCE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7211
Mailing Address - Country:US
Mailing Address - Phone:706-543-5858
Mailing Address - Fax:
Practice Address - Street 1:1180 RESURGENCE DR STE 100
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7211
Practice Address - Country:US
Practice Address - Phone:706-543-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.136867207N00000X
GA91550207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0360105Medicaid