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General NPI Number Information
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NPI Number | 1679117915
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Entity Type | Individual
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Provider Name | MATRILLA BARNES HALL LMP, CNMT, CMA
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Gender | Female
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 120 MILLBROOK VILLAGE DR # B202
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City | TYRONE
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State | GA
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Zip | 30290-3605
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Country | US
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Telephone | 404-992-0812
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 311691
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City | ATLANTA
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State | GA
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Zip | 31131-1691
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Country | US
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Telephone | 678-643-1201
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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 | MT002361
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License Number State | GA
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