MEDICARE: DR. ADAM MCTIGHE PSY.D., MBA

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	103T00000X	Psychologist	17	FL
2	103T00000X	Psychologist	18978	PA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	103T00000X	Psychologist	4000	GA

General Provider Information

NPI Number	:	1578964979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM MCTIGHE PSY.D., MBA

Provider Business Mailing Address
First Line	:	3545 BROAD ST UNIT 660156
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30366-2123
Country	:	US
Telephone Number	:	404-275-4604
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 BROAD ST UNIT 660156
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30366-2123
Country	:	US
Telephone Number	:	404-275-4604
Fax Number	:

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

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/08/2023

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