Provider Demographics
NPI:1750512471
Name:GEORGIA THERAPEUTIC MASSAGE LLC
Entity type:Organization
Organization Name:GEORGIA THERAPEUTIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:706-651-0202
Mailing Address - Street 1:7013 EVANS TOWN CENTER BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5117
Mailing Address - Country:US
Mailing Address - Phone:706-651-0202
Mailing Address - Fax:706-651-0333
Practice Address - Street 1:7013 EVANS TOWN CENTER BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5117
Practice Address - Country:US
Practice Address - Phone:706-651-0202
Practice Address - Fax:706-651-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000543172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty