Healthcare Provider Details

I. General information

NPI: 1619880986
Provider Name (Legal Business Name): BILLIE JO DEBRA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 BILL WIGINGTON PKWY STE B103
JASPER GA
30143-6861
US

IV. Provider business mailing address

61 BILL WIGINGTON PKWY STE B103
JASPER GA
30143-6861
US

V. Phone/Fax

Practice location:
  • Phone: 404-805-0857
  • Fax:
Mailing address:
  • Phone: 404-805-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT000292
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: