Healthcare Provider Details

I. General information

NPI: 1548109986
Provider Name (Legal Business Name): ANTHONY NEAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 PEACHTREE BLVD STE E170
CHAMBLEE GA
30341-3010
US

IV. Provider business mailing address

1946 TIMBERWOOD TRCE
DECATUR GA
30032-5277
US

V. Phone/Fax

Practice location:
  • Phone: 770-392-9299
  • Fax:
Mailing address:
  • Phone: 404-232-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT013564
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: