Healthcare Provider Details

I. General information

NPI: 1891350062
Provider Name (Legal Business Name): ELIZABETH OSBURN RIGGINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH OSBURN THRIFT LMT

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MAIN ST
BLACKSHEAR GA
31516-1904
US

IV. Provider business mailing address

4472 MOLLY BRANCH RD
BLACKSHEAR GA
31516-4134
US

V. Phone/Fax

Practice location:
  • Phone: 912-282-9060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT000535
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: