Individual
SHAJUAN VIRGIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.PED., LMT
Contact information
Practice address
108 BAYTREE DR, THOMASVILLE, GA 31792-8861
(678) 682-4493
Mailing address
PO BOX 2428, ACWORTH, GA 30102-0008
(678) 682-4493
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
CPED4585
GA
225700000X
Massage Therapist
Primary
MT001526
GA
Other
Enumeration date
01/18/2021
Last updated
01/18/2021
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