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General NPI Number Information
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NPI Number | 1144455536
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Entity Type | Individual
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Provider Name | RAY BLOUNT LNMT
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Gender | Male
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 1874 PIEDMONT RD NE 480D
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City | ATLANTA
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State | GA
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Zip | 30324-4869
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Country | US
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Telephone | 404-226-3590
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Fax |
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Provider Business Mailing Address
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Address Line | 2175 LENOX RD NE C4
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City | ATLANTA
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State | GA
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Zip | 30324-4733
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Country | US
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Telephone | 404-226-3590
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MT000031
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License Number State | GA
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