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General NPI Number Information
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NPI Number | 1093592115
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Entity Type | Organization
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Legal Business Name | BEYOND A SPA
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 2111 FLAT SHOALS RD SE STE 102
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City | CONYERS
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State | GA
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Zip | 30013-1826
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Country | US
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Telephone | 470-989-2473
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Fax |
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Provider Business Mailing Address
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Address Line | 2137 HICKORY BND SE APT B
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City | CONYERS
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State | GA
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Zip | 30013-2117
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Country | US
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Telephone | 770-349-5990
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAHANNIE WILLIAMS
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Credential | LMT
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Telephone | 470-989-2473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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