MEDICARE: THADDEUS MCNAUGHTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist
2	101YP2500X	Professional Counselor	APC008142	GA

General Provider Information

NPI Number	:	1164821799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THADDEUS MCNAUGHTON

Provider Business Mailing Address
First Line	:	2850 JOHNSON FERRY RD STE 200250
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5684
Country	:	US
Telephone Number	:	678-691-8130
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 JOHNSON FERRY RD STE 200250
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5684
Country	:	US
Telephone Number	:	678-691-8130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	03/01/2022

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Directions to “ THADDEUS MCNAUGHTON ” Practice Location

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