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General NPI Number Information
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NPI Number | 1770179350
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Entity Type | Individual
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Provider Name | CANTRELLA V COFIELD LMT
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Gender | Female
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 1276 RALPH DAVID ABERNATHY BLVD SW STE 204
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City | ATLANTA
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State | GA
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Zip | 30310-1752
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Country | US
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Telephone | 678-241-4470
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Fax |
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Provider Business Mailing Address
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Address Line | 1489 AVON AVE SW
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City | ATLANTA
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State | GA
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Zip | 30311-2701
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Country | US
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Telephone | 404-783-0386
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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 | MT2001327
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License Number State | GA
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