Healthcare Provider Details

I. General information

NPI: 1740144013
Provider Name (Legal Business Name): LAURA PEYTON CUNNINGHAM-WARD LMT, MMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 HOUSTON LAKE RD SUITE 103
PERRY GA
31069
US

IV. Provider business mailing address

271 LAKESHORE DR
WARNER ROBINS GA
31088-3913
US

V. Phone/Fax

Practice location:
  • Phone: 478-244-4715
  • Fax:
Mailing address:
  • Phone: 478-365-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT012802
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: