=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649560574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACE IS AT HAND, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2011
-----------------------------------------------------
Last Update Date | 04/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3053 ELMWOOD CT
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30349-8102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-755-3601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3053 ELMWOOD CT
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30349-8102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-755-3601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MASSAGE THERAPIST
-----------------------------------------------------
Name | MS. SHERRIE CHARMANIE THORNHILL
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 678-755-3601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | MT001943
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------