Healthcare Provider Details

I. General information

NPI: 1699279141
Provider Name (Legal Business Name): ARIEL SHELL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 ROLLING ROCK CT
LITHIA SPRINGS GA
30122
US

IV. Provider business mailing address

2060 ROLLING ROCK CT
LITHIA SPRINGS GA
30122-3651
US

V. Phone/Fax

Practice location:
  • Phone: 678-561-0086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT007793
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: