Provider Demographics
NPI:1871190421
Name:MILLS, AUDRA MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:MICHELLE
Last Name:MILLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 PARKER RD NW
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-8111
Mailing Address - Country:US
Mailing Address - Phone:706-263-1344
Mailing Address - Fax:
Practice Address - Street 1:HEALING HANDS MASSAGE STUDIO
Practice Address - Street 2:1270 DEWS POND RD NE
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701
Practice Address - Country:US
Practice Address - Phone:706-383-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist