Healthcare Provider Details

I. General information

NPI: 1104644129
Provider Name (Legal Business Name): ALLISON UZEBU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 AZTEC RD APT 11F
ATLANTA GA
30340-3246
US

IV. Provider business mailing address

3379 AZTEC RD APT 11F
ATLANTA GA
30340-3246
US

V. Phone/Fax

Practice location:
  • Phone: 770-334-1044
  • Fax:
Mailing address:
  • Phone: 770-334-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT004408
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: