Provider Demographics
NPI:1598918989
Name:GAINES, CAROL LACDAWN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LACDAWN
Last Name:GAINES
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3837 LAUREL CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039
Mailing Address - Country:US
Mailing Address - Phone:770-979-8869
Mailing Address - Fax:770-979-8869
Practice Address - Street 1:3837 LAUREL CREST DRIVE
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039
Practice Address - Country:US
Practice Address - Phone:770-979-8869
Practice Address - Fax:770-979-8869
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000493225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist