Healthcare Provider Details

I. General information

NPI: 1285819367
Provider Name (Legal Business Name): THOMAS MICHAEL MEGUIAR PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS M MEGUIAR PHD

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WILTON SPRINGS RD
NEWPORT TN
37821-6405
US

IV. Provider business mailing address

103 WILTON SPRINGS RD
NEWPORT TN
37821-6405
US

V. Phone/Fax

Practice location:
  • Phone: 423-487-2222
  • Fax: 423-623-7787
Mailing address:
  • Phone: 423-487-2222
  • Fax: 423-623-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP1279
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: