Provider Demographics
NPI:1972957462
Name:SERVY, ALEXIS EDOUARD (NCTMB, CMT, NMT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:EDOUARD
Last Name:SERVY
Suffix:
Gender:M
Credentials:NCTMB, CMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 PIEDMONT AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3702
Mailing Address - Country:US
Mailing Address - Phone:678-232-6433
Mailing Address - Fax:
Practice Address - Street 1:1016 PIEDMONT AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3702
Practice Address - Country:US
Practice Address - Phone:678-232-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003953173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMT003953OtherGEORGIA BOARD OF MASSAGE THERAPY
GA529241-07OtherNATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE & BODYWORK (NCBTMB)