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Individual

LASHAWNA ERVIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
650 PONCE DE LEON AVE NE, ATLANTA, GA 30308-1804
(678) 895-0198
Mailing address
1115 MARSH TRAIL CIR, ATLANTA, GA 30328-5737

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT012536
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MT012536
MASSAGE THERAPY
GA
Enumeration date
10/14/2020
Last updated
10/14/2020
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