MEDICARE: ANGELA WEADON MM, LPMT, MT-BC

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	225A00000X	Music Therapist	MUT000038	GA

General Provider Information

NPI Number	:	1366741167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WEADON MM, LPMT, MT-BC

Provider Business Mailing Address
First Line	:	308 CLAIREMONT AVE
Second Line	:	STE S-324
City	:	DECATUR
State	:	GA
Zip	:	30030-2506
Country	:	US
Telephone Number	:	678-664-4992
Fax Number	:	678-403-0344

Provider Business Practice Location Address
First Line	:	308 CLAIREMONT AVE
Second Line	:	STE S-324
City	:	DECATUR
State	:	GA
Zip	:	30030-2506
Country	:	US
Telephone Number	:	678-664-4992
Fax Number	:	678-403-0344

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

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	08/18/2022

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