Individual
MISS KIMBERLY JAVON GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
211 PLEASANT HOME RD, SUITE F-1, AUGUSTA, GA 30907-0518
(706) 863-9705
Mailing address
511 ELLINGTON AVE, THOMSON, GA 30824-1624
(706) 863-9705
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT007434
GA
Other
Enumeration date
01/09/2012
Last updated
01/09/2012
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