Individual
MRS. JANINE CELIA WILLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T., C.N.M.T
Contact information
Practice address
2080 FAIRBURN RD, SUITE G, DOUGLASVILLE, GA 30135-1064
(678) 213-4266
Mailing address
204 LOST LAKE WAY, VILLA RICA, GA 30180-4864
(770) 630-6942
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
MT006850
GA
172M00000X
Mechanotherapist
Primary
MT006850
GA
Other
Enumeration date
09/18/2012
Last updated
09/18/2012
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