Provider Demographics
NPI:1235742008
Name:ADAMS, GEORGIA (LMT)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AURA
Other - Middle Name:
Other - Last Name:RAVENCRAFT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18006 DANIELSON ST APT 203
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-6085
Mailing Address - Country:US
Mailing Address - Phone:661-436-5438
Mailing Address - Fax:
Practice Address - Street 1:26893 BOUQUET CANYON RD STE F
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2374
Practice Address - Country:US
Practice Address - Phone:661-436-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist