Individual
EVONDA WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1205 ARBOR CROSSING DR, LITHONIA, GA 30058-3814
(678) 478-9626
Mailing address
1205 ARBOR CROSSING DR, LITHONIA, GA 30058-3814
(678) 478-9626
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT009446
GA
Other
Enumeration date
12/15/2022
Last updated
12/15/2022
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