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General NPI Number Information
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NPI Number | 1720939812
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Entity Type | Organization
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Legal Business Name | EBONY'S MASSAGE ESCAPE, LLC
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Dates
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Enumeration Date | 02/05/2026
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 8326 OFFICE PARK DR STE B
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6936
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Country | US
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Telephone | 470-810-1097
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Fax |
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Provider Business Mailing Address
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Address Line | 8326 OFFICE PARK DR STE B
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6936
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Country | US
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Telephone | 470-810-1097
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | MS. EBONY S WATSON
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Credential | LMT
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Telephone | 470-810-1097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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