Healthcare Provider Details

I. General information

NPI: 1609946177
Provider Name (Legal Business Name): SATISH NAIR N.D, LMT,MMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 CLUB DR
LAWRENCEVILLE GA
30044-3224
US

IV. Provider business mailing address

2841 CLUB DR
LAWRENCEVILLE GA
30044-3224
US

V. Phone/Fax

Practice location:
  • Phone: 678-558-5776
  • Fax: 678-807-2843
Mailing address:
  • Phone: 678-558-5776
  • Fax: 678-807-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNCTMB 40193100
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: