Provider Demographics
NPI:1073971982
Name:PREMIER SPA & WELLNESS
Entity Type:Organization
Organization Name:PREMIER SPA & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIC MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:VOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:770-369-3606
Mailing Address - Street 1:2050 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3811
Mailing Address - Country:US
Mailing Address - Phone:770-369-3606
Mailing Address - Fax:770-977-9299
Practice Address - Street 1:2050 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3811
Practice Address - Country:US
Practice Address - Phone:770-369-3606
Practice Address - Fax:770-977-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMA003861174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty