MEDICARE: EMMOUNE DENISE FOREST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT013762	GA

General Provider Information

NPI Number	:	1063165918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMOUNE DENISE FOREST

Provider Business Mailing Address
First Line	:	4449 ROCK VALLEY DR
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-1580
Country	:	US
Telephone Number	:	678-699-9609
Fax Number	:

Provider Business Practice Location Address
First Line	:	3802 N DRUID HILLS RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3015
Country	:	US
Telephone Number	:	404-486-9644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/01/2022

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Directions to “ EMMOUNE DENISE FOREST ” Practice Location

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