Provider Demographics
NPI:1265688428
Name:POOR, CANDICE E (BA, NCTM)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:E
Last Name:POOR
Suffix:
Gender:F
Credentials:BA, NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 FRANCIS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5933
Mailing Address - Country:US
Mailing Address - Phone:678-538-7134
Mailing Address - Fax:
Practice Address - Street 1:3442 FRANCIS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-5933
Practice Address - Country:US
Practice Address - Phone:678-538-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist