Organization
MYSTIC MASSAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNA LEE GOODE LMT (OWNER/OPERATOR)
(404) 914-1822
Entity
Organization
Contact information
Practice address
8725 ROSWELL RD, ATLANTA, GA 30350-7533
(404) 914-1822
Mailing address
2408 SUMMERLAKE DR, ATLANTA, GA 30350-3054
(404) 914-1822
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT000319
GA
Other
Enumeration date
06/27/2008
Last updated
06/27/2008
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