Healthcare Provider Details

I. General information

NPI: 1558098582
Provider Name (Legal Business Name): CHRISTEL OWONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CREEKSTONE RDG STE 20
WOODSTOCK GA
30188-3744
US

IV. Provider business mailing address

10247 HIGHWAY 92 # 300-204
WOODSTOCK GA
30188-3914
US

V. Phone/Fax

Practice location:
  • Phone: 770-256-6117
  • Fax:
Mailing address:
  • Phone: 770-256-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT012745
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: