Healthcare Provider Details

I. General information

NPI: 1992025019
Provider Name (Legal Business Name): RICHARD P DELAMAR LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 HOSPITAL DR SUITE 7G
STOCKBRIDGE GA
30281-6393
US

IV. Provider business mailing address

1129 HOSPITAL DR SUITE 7G
STOCKBRIDGE GA
30281-6393
US

V. Phone/Fax

Practice location:
  • Phone: 678-759-0096
  • Fax: 678-609-1360
Mailing address:
  • Phone: 678-759-0096
  • Fax: 678-609-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT005325
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT005325
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: