Individual
MR. DANDY NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NMT, LMT
Contact information
Practice address
6065 ROSWELL RD STE 170, ATLANTA, GA 30328-4034
(512) 589-7274
Mailing address
5966 HERITAGE LN, STONE MOUNTAIN, GA 30087-1858
(512) 589-7274
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
MT009639
GA
225700000X
Massage Therapist
Primary
MT009639
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT009639
MASSAGE LICENSE
GA
Enumeration date
10/26/2016
Last updated
05/06/2024
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