Provider Demographics
NPI:1407261951
Name:DANAMARIE DERIGGI
Entity Type:Organization
Organization Name:DANAMARIE DERIGGI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERIGGI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:678-361-8104
Mailing Address - Street 1:500 BISHOP ST NW
Mailing Address - Street 2:SUITE F7
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4366
Mailing Address - Country:US
Mailing Address - Phone:678-361-8104
Mailing Address - Fax:
Practice Address - Street 1:500 BISHOP ST
Practice Address - Street 2:STE F7
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4378
Practice Address - Country:US
Practice Address - Phone:678-361-8104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT009005251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable