Provider Demographics
NPI:1679187355
Name:NOWELL, ANNETTA (LMT, NCBTMB)
Entity Type:Individual
Prefix:MS
First Name:ANNETTA
Middle Name:
Last Name:NOWELL
Suffix:
Gender:F
Credentials:LMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PINE ST NW UNIT 202
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-4516
Mailing Address - Country:US
Mailing Address - Phone:678-768-9222
Mailing Address - Fax:
Practice Address - Street 1:152 PINE ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30313-2212
Practice Address - Country:US
Practice Address - Phone:678-806-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001224225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist