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General NPI Number Information
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NPI Number | 1598244253
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Entity Type | Organization
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Legal Business Name | MEDICAL MASSAGE OF COWETA, LLC
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 3025B SHARPSBURG MCCULLUM RD STE 108
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City | NEWNAN
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State | GA
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Zip | 30265-6107
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Country | US
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Telephone | 678-590-8040
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Fax | 347-823-8404
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Provider Business Mailing Address
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Address Line | 3025B HWY 154 SUITE 108
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City | NEWNAN
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State | GA
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Zip | 30265-6107
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Country | US
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Telephone | 678-590-8040
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Fax | 347-823-8404
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Authorized Official
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Title or Position | MEDICAL MASSAGE THERAPIST
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Name | MRS. ANGELA TALLEY
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Credential | LMT, MMP
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Telephone | 678-590-8040
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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 | MT002072
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License Number State | GA
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