Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT009639 | GA |
NPI | 1013469915 |
---|---|
Provider Name | Mr. Dandy Nichols |
First Address | Atlanta, GA 30305-1506 |
Second Address | Atlanta, GA 30305-1506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2016 |
Last Update Date | 26/10/2016 |