MEDICARE: SADIE GRAHAM MCWHORTER

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1558133769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADIE GRAHAM MCWHORTER

Provider Business Mailing Address
First Line	:	1040 HUFF RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4167
Country	:	US
Telephone Number	:	706-239-1252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 HUFF RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4167
Country	:	US
Telephone Number	:	706-239-1252
Fax Number	:

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

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	10/23/2023

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Directions to “ SADIE GRAHAM MCWHORTER ” Practice Location

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