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General NPI Number Information
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NPI Number | 1720230436
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Entity Type | Individual
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Provider Name | SAFIYAH WALCOTT-FARRAKHAN NMT
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Gender | Female
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 5813 BOBBIN LN
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City | LITHONIA
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State | GA
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Zip | 30058-5410
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Country | US
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Telephone | 404-917-9348
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Fax |
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Provider Business Mailing Address
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Address Line | 500 BISHOP ST NW STE F7
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City | ATLANTA
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State | GA
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Zip | 30318-4378
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Country | US
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Telephone | 404-781-9288
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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 | MT000795
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License Number State | GA
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