Healthcare Provider Details

I. General information

NPI: 1700791811
Provider Name (Legal Business Name): THE ATHLETIC STANDARD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HUDSON TRCE STE C
AUGUSTA GA
30907-2027
US

IV. Provider business mailing address

4063 BRIARWOOD DR
MARTINEZ GA
30907-2611
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-8055
  • Fax:
Mailing address:
  • Phone: 706-842-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL MARTIN
Title or Position: OWNER/MASSAGE THERAPIST
Credential: LMT, MMP, BSKIN
Phone: 706-842-8055