Individual
MR. SHUUICHI ODA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1340 GRAN FOREST DR, CUMMING, GA 30041-6599
(770) 889-5406
Mailing address
1340 GRAN FOREST DR, CUMMING, GA 30041-6599
(770) 889-5406
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT006906
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
985492
ABMP INSURANCE COVERAGE
CO
01
—
MT006906
GA STATE LICENCED MASSAGE THERAPIST
GA
Enumeration date
01/03/2012
Last updated
05/14/2013
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