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General NPI Number Information
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NPI Number | 1629923222
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Entity Type | Individual
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Provider Name | JAMAICA BIONKA MATTOX
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Gender | Female
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Dates
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Enumeration Date | 02/28/2026
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Last Update Date | 02/28/2026
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Provider Practice Location Address
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Address Line | 2993 SANDY PLAINS RD STE 225
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City | MARIETTA
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State | GA
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Zip | 30066-4695
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Country | US
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Telephone | 740-487-2232
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Fax | 740-487-2232
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Provider Business Mailing Address
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Address Line | 2556 FAIRLAWN DOWNS NW
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City | KENNESAW
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State | GA
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Zip | 30144-6181
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Country | US
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Telephone | 740-487-2232
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Fax | 740-487-2232
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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 | MT014132
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License Number State | GA
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