MR. MATTHEW WAGNER (NPI# 1053749168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053749168 |
| Entity Type | Individual |
| Full Name | MR. MATTHEW WAGNER |
| Credential | LPC, CAADC |
| Practice Address |
545 N Mcdonough St Ste 212 Decatur GA 30030-3310 |
| Practice Telephone | 7707668128 |
| Mailing Telephone | 7707668128 |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2018-11-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
C0212 | GA | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
9583 | GA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1538534334 | Matthew Wagner | Acupuncturist | 4513 Vernon Blvd, Madison, WI 53705-4993 | 2015-12-04 |
| 1114198751 | Matthew Robert Wagner | Orthopaedic Surgery | 1500 Route 112 Bldg 2c, Port Jefferson Station, NY 11776-8055 | 2008-03-21 |
| 1700415965 | Matthew Anthony Wagner | Student in an Organized Health Care Education/Training Program | 1500 E Sherman Blvd, Muskegon, MI 49444-1849 | 2020-04-08 |
| 1376177048 | Matthew Gary Wagner | Case Manager/Care Coordinator | 16 W Long St, Columbus, OH 43215-2815 | 2020-03-02 |
| 1235613738 | Matthew James Wagner | Pharmacist | 17213 Cole Rd, Hagerstown, MD 21740-6981 | 2018-09-20 |
| 1164918199 | Matthew Steven Wagner | Internal Medicine | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2018-07-02 |
| 1609371244 | Matthew Anthony Wagner | Student in an Organized Health Care Education/Training Program | 509 Biltmore Ave, Asheville, NC 28801-4601 | 2018-03-26 |
| 1669994752 | Matthew Wagner | Behavior Technician | 415 Medical Dr Ste D101, Bountiful, UT 84010-8905 | 2017-07-11 |
| 1174973432 | Matthew Wagner | Peer Specialist | 190 Match Factory Pl, Bellefonte, PA 16823-1367 | 2016-06-17 |
| Street Address |
545 N MCDONOUGH ST STE 212 |
| City | DECATUR |
| State | GA |
| Zip Code | 30030-3310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801413174 | Pa-c Surgical Assist, LLC | Clinic/Center | 520 W Ponce Leon Ave #1706, Decatur, GA 30030 | 2020-07-02 |
| 1417587478 | Elizabeth Heffron | Acupuncturist | 619b East College Avenue, Decatur, GA 30030 | 2020-01-17 |
| 1669016143 | Atlanta Upper Cervical Chiropractic LLC | Chiropractor | 125 E Trinity Place, Suite #247, Decatur, GA 30030 | 2019-10-29 |
| 1831757418 | Jessica Stewart | Counselor | 755 Commerce Dr Ste 903, Decatur, GA 30030 | 2019-05-30 |
| 1699238733 | Dinah Augustin | Registered Nurse | 1458 Church St., Unit B, Decatur, GA 30030 | 2019-04-06 |
| 1093284291 | Eliza Segell | Social Worker | 165 Dekalb Industrial Way Ste D-1, Decatur, GA 30030 | 2018-11-16 |
| 1912476466 | Positive Impact Health Centers, Inc. | Pharmacy | 523 Church Street, Suite B, Decatur, GA 30030 | 2018-11-14 |
| 1932685096 | T2 Imaging | Radiology | 1376 Church Street, Suite 100, Decatur, GA 30030 | 2018-07-12 |
| 1992292858 | Keeanna M Powell | Counselor | Agape Transformation Practice, 235 E. Ponce De Leon Ave Suite 103, Decatur, GA 30030 | 2018-04-17 |
| 1780185488 | Solutions Ae Inc | Counselor | One West Square Court, Suite 710, Decatur, GA 30030 | 2018-02-27 |
| Find all providers in zip 30030 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598363392 | Kimberly Swanson | Counselor | 311 West Hill Street, Decatur, GA 30030-4319 | 2020-10-14 |
| 1083228050 | Lasonja D Carter | Counselor | 2920 Frost Dr Sw, Decatur, AL 35603-4531 | 2020-09-07 |
| 1154935468 | Nick Hersey | Counselor | 1924 Clairmont Rd Ste 50, Decatur, GA 30033-3450 | 2020-09-03 |
| 1760095814 | Potters Touch Counseling Inc. | Counselor | 4150 Snapfinger Woods Dr Ste 100, Decatur, GA 30035-3417 | 2020-08-28 |
| 1407464563 | Starre Cannon | Counselor | 3183 Tarian Way, Decatur, GA 30034-5539 | 2020-07-15 |
| 1164040713 | Bethany Cecelia Merrett | Counselor | 223 Kathryn Ave, Decatur, GA 30030-5017 | 2020-07-09 |
| 1053939090 | Virtue Speaks LLC | Counselor | 4150 Snapfinger Woods Dr Ste 104d, Decatur, GA 30035-3417 | 2020-07-07 |
| 1821619842 | Knitikia Gross | Counselor | 436 Eastwyck Cir, Decatur, GA 30032-6694 | 2020-04-30 |
| 1063033074 | Marcy Renee Jefferson-watkins | Counselor | 2126 6th Ave Se Ste 208, Decatur, AL 35601-6547 | 2020-04-30 |
| 1790304004 | Tonia D Morris | Counselor | 3006 Western Sunset Ct, Decatur, GA 30034-1692 | 2020-04-16 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.