Provider Demographics
NPI:1740975218
Name:WORD, YJUANIA (LCMT)
Entity type:Individual
Prefix:
First Name:YJUANIA
Middle Name:
Last Name:WORD
Suffix:
Gender:M
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 JULIUS DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5904
Mailing Address - Country:US
Mailing Address - Phone:404-626-9708
Mailing Address - Fax:
Practice Address - Street 1:3293 STONE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6856
Practice Address - Country:US
Practice Address - Phone:678-785-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001236225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist