George Glen Massengill, LADAC
Counselor, Addiction (Substance Use Disorder) in Jacksboro, TN. Individual provider (NPI-1).
NPI number1033447263
StatusActive
Last updated in NPPESNov 30, 2009
Details
- NPI
- 1033447263
- Entity type
- Individual (NPI-1)
- Name
- Mr. George Glen Massengill
- Credential
- LADAC
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 30, 2009
- Last updated
- Nov 30, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | 580 | TN | Yes |
Practice location
188 Indian Mound CirJacksboro, TN 37757-2100
Phone 423-566-2437 · Fax 423-566-2948
Mailing address
188 Indian Mound CirJacksboro, TN 37757-2100
Phone 423-566-2437 · Fax 423-566-2948
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