Provider Demographics
NPI:1770857658
Name:ADVANCED MASSAGE NETWORK, LLC.
Entity Type:Organization
Organization Name:ADVANCED MASSAGE NETWORK, LLC.
Other - Org Name:YOUR MEDICAL MASSAGE RESOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:EDOUARD
Authorized Official - Last Name:SERVY
Authorized Official - Suffix:
Authorized Official - Credentials:NCTMB, CMT, LMT
Authorized Official - Phone:706-951-5970
Mailing Address - Street 1:1170 14TH PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3505
Mailing Address - Country:US
Mailing Address - Phone:404-482-1633
Mailing Address - Fax:
Practice Address - Street 1:1170 14TH PL NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3505
Practice Address - Country:US
Practice Address - Phone:678-232-6433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT006682173C00000X
SC5872173C00000X
GAMT003953173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty