MEDICARE: ATL BODYWORKS , LLC

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	:	1184209975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATL BODYWORKS , LLC

Provider Business Mailing Address
First Line	:	PO BOX 12187
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30355-2187
Country	:	US
Telephone Number	:	770-765-1076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 PEACHTREE ST NE UNIT 3
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3912
Country	:	US
Telephone Number	:	770-765-1076
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KALA EVANS
Credential	:	MASSAGE THERAPIST
Telephone Number	:	770-765-1076

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	03/12/2021

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Directions to “ATL BODYWORKS , LLC ” Practice Location

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