Healthcare Provider Details

I. General information

NPI: 1225932338
Provider Name (Legal Business Name): AARON THOMAS BIVINS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 VINERY AVE
CUMMING GA
30041-9719
US

IV. Provider business mailing address

1790 VINERY AVE
CUMMING GA
30041-9719
US

V. Phone/Fax

Practice location:
  • Phone: 770-375-6467
  • Fax:
Mailing address:
  • Phone: 770-375-6467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT016038
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: