Provider Demographics
NPI:1972218634
Name:HOWARD, JOHN ROGER (LMT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROGER
Last Name:HOWARD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:785 BROOKFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1339
Mailing Address - Country:US
Mailing Address - Phone:770-815-3365
Mailing Address - Fax:770-559-1377
Practice Address - Street 1:425 E CROSSVILLE RD BLDG E117
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5817
Practice Address - Country:US
Practice Address - Phone:770-815-3365
Practice Address - Fax:770-559-1377
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAMT002148225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist