Healthcare Provider Details

I. General information

NPI: 1013162783
Provider Name (Legal Business Name): CRISTAUF EYRAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2008
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 W COURT SQ
NEWNAN GA
30263-2051
US

IV. Provider business mailing address

5935 CATAWBA WAY
ATLANTA GA
30349-1558
US

V. Phone/Fax

Practice location:
  • Phone: 470-705-4213
  • Fax:
Mailing address:
  • Phone: 470-292-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT014698
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: