MEDICARE: JOY NICOLE ANDERSON LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT004823	GA

General Provider Information

NPI Number	:	1720317720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY NICOLE ANDERSON LMT

Provider Business Mailing Address
First Line	:	6710 JAMESTOWN DR
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3030
Country	:	US
Telephone Number	:	770-558-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	6710 JAMESTOWN DR
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3030
Country	:	US
Telephone Number	:	770-558-6900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2009
Last Update Date	:	12/22/2009

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