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General NPI Number Information
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NPI Number | 1275138786
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Entity Type | Individual
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Provider Name | AMABY MEJIA
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Gender | Female
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 2275 WRIGHTSBORO RD
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City | AUGUSTA
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State | GA
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Zip | 30904-4717
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Country | US
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Telephone | 803-439-7245
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Fax |
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Provider Business Mailing Address
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Address Line | 543 VILLAGE EAST CIR
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City | GRANITEVILLE
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State | SC
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Zip | 29829-6022
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Country | US
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Telephone | 803-439-7245
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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 | MT011037
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License Number State | GA
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