Individual
DIANA CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, NCTMB
Contact information
Practice address
1799 CLAIRMONT RD, DECATUR, GA 30033-4005
(404) 432-2618
Mailing address
606 N CROSSING WAY, DECATUR, GA 30033-4144
(404) 432-2618
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
006193
GA
Other
Enumeration date
03/09/2010
Last updated
03/09/2010
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