MEDICARE: THOMAS MICHAEL MEGUIAR PHD

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	103TC0700X	Clinical Psychologist	P1279	TN

General Provider Information

NPI Number	:	1285819367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MICHAEL MEGUIAR PHD

Provider Business Mailing Address
First Line	:	103 WILTON SPRINGS RD
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-6405
Country	:	US
Telephone Number	:	423-487-2222
Fax Number	:	423-623-7787

Provider Business Practice Location Address
First Line	:	103 WILTON SPRINGS RD
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-6405
Country	:	US
Telephone Number	:	423-487-2222
Fax Number	:	423-623-7787

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

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	06/15/2015

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