Provider Demographics
NPI:1558809376
Name:MAJOR, DADRA (LMT)
Entity Type:Individual
Prefix:
First Name:DADRA
Middle Name:
Last Name:MAJOR
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 1:2455 AMSTERDAM DRIVE
Mailing Address - Street 2:APT 2E
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906
Mailing Address - Country:US
Mailing Address - Phone:706-284-0946
Mailing Address - Fax:
Practice Address - Street 1:4434 COLUMBIA RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4556
Practice Address - Country:US
Practice Address - Phone:706-530-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT009885225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist