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General NPI Number Information
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NPI Number | 1710794524
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Entity Type | Individual
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Provider Name | JAYELYN LIVINGSTON LMT
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 1875 HOLSTON DR
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City | JONESBORO
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State | GA
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Zip | 30236-3908
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Country | US
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Telephone | 770-309-7686
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Fax |
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Provider Business Mailing Address
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Address Line | 2045 MOUNT ZION RD # 111
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City | MORROW
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State | GA
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Zip | 30260-3313
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Country | US
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Telephone | 404-734-7771
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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 | MT014534
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License Number State | GA
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