Healthcare Provider Details

I. General information

NPI: 1265369557
Provider Name (Legal Business Name): MS. LINDA ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 OLD SALEM RD NE SUITE K9
CONYERS GA
30013
US

IV. Provider business mailing address

1439 OLD SALEM RD NE SUITE K9
CONYERS GA
30013
US

V. Phone/Fax

Practice location:
  • Phone: 404-803-0843
  • Fax:
Mailing address:
  • Phone: 404-803-0843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT011580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: