Provider Demographics
NPI:1497329171
Name:MUNLIN, FOY CLYDE JR (MT)
Entity Type:Individual
Prefix:
First Name:FOY
Middle Name:CLYDE
Last Name:MUNLIN
Suffix:JR
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 LOVELL DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-3672
Mailing Address - Country:US
Mailing Address - Phone:469-472-6106
Mailing Address - Fax:
Practice Address - Street 1:2950 STONE HOGAN CONNECTOR RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2837
Practice Address - Country:US
Practice Address - Phone:404-781-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012170225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist