Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT004927 | GA |
NPI | 1003148925 |
---|---|
Provider Name | Julian Davis Mills |
First Address | Snellville, GA 30078-5021 |
Second Address | Snellville, GA 30078-5021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2010 |
Last Update Date | 15/03/2017 |