Individual
TAMATHA DALE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C-MMP
Contact information
Practice address
102 MIRRAMONT LAKE DR, WOODSTOCK, GA 30189-8213
(678) 492-9600
Mailing address
109 GOPHER CT, WALESKA, GA 30183-4303
(678) 492-9600
(678) 492-9600
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT007252
GA
Other
Enumeration date
02/26/2026
Last updated
02/26/2026
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