Healthcare Provider Details

I. General information

NPI: 1699222893
Provider Name (Legal Business Name): EMILY DUDEN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 S HOUSTON LAKE RD STE 2
WARNER ROBINS GA
31088-8017
US

IV. Provider business mailing address

158 S HOUSTON LAKE RD STE 2
WARNER ROBINS GA
31088-8017
US

V. Phone/Fax

Practice location:
  • Phone: 478-202-7260
  • Fax:
Mailing address:
  • Phone: 478-202-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT009570
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT9570
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: