Healthcare Provider Details

I. General information

NPI: 1447304829
Provider Name (Legal Business Name): MEGAN LEIGH WEATHERFORD NMT, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD SUITE B-145
MARIETTA GA
30068-2114
US

IV. Provider business mailing address

4103 WOODLAND LN
ALPHARETTA GA
30004-8742
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-6560
  • Fax: 678-560-6691
Mailing address:
  • Phone: 770-572-2889
  • Fax: 678-560-6691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number07178
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: