Healthcare Provider Details

I. General information

NPI: 1588573430
Provider Name (Legal Business Name): JULIE POULNOT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 LOGANVILLE HWY STE 202
GRAYSON GA
30017-1657
US

IV. Provider business mailing address

4160 LOGAN DR PO BOX 3228
LOGANVILLE GA
30052-9998
US

V. Phone/Fax

Practice location:
  • Phone: 470-451-5936
  • Fax:
Mailing address:
  • Phone: 470-451-5936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT014982
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: