Provider Demographics
NPI:1093592115
Name:BEYOND A SPA
Entity Type:Organization
Organization Name:BEYOND A SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAHANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:470-989-2473
Mailing Address - Street 1:2137 HICKORY BND SE APT B
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2117
Mailing Address - Country:US
Mailing Address - Phone:770-349-5990
Mailing Address - Fax:
Practice Address - Street 1:2111 FLAT SHOALS RD SE STE 102
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1826
Practice Address - Country:US
Practice Address - Phone:470-989-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty