Healthcare Provider Details

I. General information

NPI: 1538333299
Provider Name (Legal Business Name): MAGDALENA ESCOBAR PMM, MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7419 SPOUT SPRINGS RD SUITE B-102
FLOWERY BRANCH GA
30542-5515
US

IV. Provider business mailing address

24 COUNTRY COVE DR
BRASELTON GA
30517-2633
US

V. Phone/Fax

Practice location:
  • Phone: 770-965-8259
  • Fax:
Mailing address:
  • Phone: 678-943-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT001463
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: