Provider Demographics
NPI:1679117915
Name:HALL, MATRILLA BARNES (LMP, CNMT, CMA)
Entity Type:Individual
Prefix:MRS
First Name:MATRILLA
Middle Name:BARNES
Last Name:HALL
Suffix:
Gender:F
Credentials:LMP, CNMT, CMA
Other - Prefix:MRS
Other - First Name:MATRILLA
Other - Middle Name:BARNES
Other - Last Name:HEIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP, CNMT, CMA
Mailing Address - Street 1:PO BOX 311691
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31131-1691
Mailing Address - Country:US
Mailing Address - Phone:678-643-1201
Mailing Address - Fax:
Practice Address - Street 1:120 MILLBROOK VILLAGE DR # B202
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-3605
Practice Address - Country:US
Practice Address - Phone:404-992-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist