Provider Demographics
NPI:1366741167
Name:WEADON, ANGELA (MM, LPMT, MT-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WEADON
Suffix:
Gender:F
Credentials:MM, LPMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CLAIREMONT AVE
Mailing Address - Street 2:STE S-324
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2506
Mailing Address - Country:US
Mailing Address - Phone:678-664-4992
Mailing Address - Fax:678-403-0344
Practice Address - Street 1:308 CLAIREMONT AVE
Practice Address - Street 2:STE S-324
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2506
Practice Address - Country:US
Practice Address - Phone:678-664-4992
Practice Address - Fax:678-403-0344
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMUT000038225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist