Provider Demographics
NPI:1609946177
Name:NAIR, SATISH (ND, LMT,MMT)
Entity Type:Individual
Prefix:MR
First Name:SATISH
Middle Name:
Last Name:NAIR
Suffix:
Gender:M
Credentials:ND, LMT,MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3224
Mailing Address - Country:US
Mailing Address - Phone:678-558-5776
Mailing Address - Fax:678-807-2843
Practice Address - Street 1:2841 CLUB DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3224
Practice Address - Country:US
Practice Address - Phone:678-558-5776
Practice Address - Fax:678-807-2843
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANCTMB 40193100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist