Individual
MACAULY BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1301 SHILOH RD NW STE 510, KENNESAW, GA 30144-7153
(678) 871-6170
Mailing address
2586 CLUB VALLEY DR NE, MARIETTA, GA 30068-3550
(770) 356-1256
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT012479
GA
Other
Enumeration date
04/22/2025
Last updated
04/22/2025
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