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NPI Code Detail

MEDICARE: DUSTIN MCGAHA

MEDICARE: DUSTIN MCGAHA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1124738125
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUSTIN MCGAHA
Provider Business Mailing Address
First Line : 2704 SOOD RD APT 17
Second Line :
City : KNOXVILLE
State : TN
Zip : 37921-2952
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6312 KINGSTON PIKE STE B
Second Line :
City : KNOXVILLE
State : TN
Zip : 37919-4958
Country : US
Telephone Number : 844-854-1116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2022
Last Update Date : 11/30/2022

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Directions to “ DUSTIN MCGAHA ” Practice Location

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