Healthcare Provider Details

I. General information

NPI: 1922927250
Provider Name (Legal Business Name): MISS KERI MONTEIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 POWDER SPRINGS ST STE 230
MARIETTA GA
30064-3689
US

IV. Provider business mailing address

3301 MARS HILL RD NW
ACWORTH GA
30101-4053
US

V. Phone/Fax

Practice location:
  • Phone: 508-406-4881
  • Fax:
Mailing address:
  • Phone: 508-406-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number015777
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: