NPI 1003078387

Mystic Massage

Organisation Specialist Atlanta, GA

Practice location

Address: 8725 Roswell Rd, Atlanta, GA 30350-7533
Phone: (404) 914-1822
Mailing address: 2408 Summerlake Dr, Atlanta, GA 30350-3054

Authorised official

Name: Anna Lee Goode
Title: Owner/Operator
Phone: (404) 914-1822

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence MT000319 (GA)

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Registry record

NPI: 1003078387
Entity type: Organization
NPI issued: 27 Jun 2008
Record last updated: 27 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.