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General NPI Number Information
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NPI Number | 1215736996
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Entity Type | Individual
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Provider Name | CHARLES JOSEPH MCNULTY LMT
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Gender | Male
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 6065 ROSWELL RD STE 170
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-4034
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Country | US
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Telephone | 404-220-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 789 HAMMOND DR APT 101
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City | ATLANTA
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State | GA
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Zip | 30328-5590
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Country | US
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Telephone | 251-599-7794
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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 | MT010389
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License Number State | GA
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