MEDICARE: SCOTT DOSS WELLNESS DBA STAR DYNAMIC WELLNESS

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

General Provider Information

NPI Number	:	1174478333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT DOSS WELLNESS DBA STAR DYNAMIC WELLNESS

Provider Business Mailing Address
First Line	:	454 BLAKE AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1720
Country	:	US
Telephone Number	:	404-937-6234
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E TRINITY PL STE 306
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-3360
Country	:	US
Telephone Number	:	404-937-6234
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	SCOTT OGLESBAY
Credential	:	OMT, LMT, BCTMB
Telephone Number	:	404-937-6234

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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