Individual
LUCAS GRANT WAKEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2803 SHALLOWFORD RD NE, ATLANTA, GA 30341-5216
(770) 903-2603
Mailing address
2803 SHALLOWFORD RD NE, ATLANTA, GA 30341-5216
(770) 903-2603
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT014388
GA
Other
Enumeration date
03/11/2026
Last updated
03/11/2026
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