Provider Demographics
NPI:1588066708
Name:MEDDLING, JOHN (LCMT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MEDDLING
Suffix:
Gender:M
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5474 OAKLEY INDUSTRIAL BLVD APT 1032
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4475
Mailing Address - Country:US
Mailing Address - Phone:678-778-2109
Mailing Address - Fax:770-774-4232
Practice Address - Street 1:5474 OAKLEY INDUSTRIAL BLVD APT 1032
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4475
Practice Address - Country:US
Practice Address - Phone:678-778-2109
Practice Address - Fax:770-774-4232
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist