Provider Demographics
NPI:1871659086
Name:HARTSFIELD, VANESSA LUCILLE (LMT, NMT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LUCILLE
Last Name:HARTSFIELD
Suffix:
Gender:F
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-8913
Mailing Address - Country:US
Mailing Address - Phone:770-987-3983
Mailing Address - Fax:
Practice Address - Street 1:180 ALLEN RD NE
Practice Address - Street 2:SUITE 103 NORTH BLDG
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4862
Practice Address - Country:US
Practice Address - Phone:678-833-5643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist