Matthew Wagner, LPC, CAADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

9583 Issued in GA

Practice address

545 N McDonough St Ste 212
Decatur, GA 30030-3310

Phone

(770) 766-8128

NPI assigned

Oct 29, 2013

Last updated

Nov 1, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: matthewwagner@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Professional

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541030400000",
    "number": "1053749168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 N MCDONOUGH ST STE 212",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303310",
            "telephone_number": "770-766-8128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 N MCDONOUGH ST STE 212",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303310",
            "telephone_number": "770-766-8128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "LPC, CAADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-29",
        "last_updated": "2018-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "C0212",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "9583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mufida Muradali Wadhwania, M.D.
• Michael Wadleigh
• Monica Maria Wadley
• Peyton Waggener
• Amanda Kay Wagner, LCSW
• Tricia Francisco Wagner
• Kristen Wagoner, LPC
• Abdul Wahab, PHD
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3710)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3118)

• Professional Counselor in Decatur, GA
• Providers in Decatur, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.