Provider Demographics
NPI:1508145822
Name:WILLIFORD, DEBBIE B (LMT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:B
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 GA HIGHWAY 171 N
Mailing Address - Street 2:
Mailing Address - City:GIBSON
Mailing Address - State:GA
Mailing Address - Zip Code:30810-4200
Mailing Address - Country:US
Mailing Address - Phone:706-598-2340
Mailing Address - Fax:706-598-2340
Practice Address - Street 1:43 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:GIBSON,
Practice Address - State:GA
Practice Address - Zip Code:30810-4200
Practice Address - Country:US
Practice Address - Phone:706-831-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000210225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist