Individual
DERICK WADE CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, LMT
Contact information
Practice address
1708 PEACHTREE ST NW STE 101, ATLANTA, GA 30309-2415
(870) 284-0297
Mailing address
2354 LITTLEBROOKE DR, DUNWOODY, GA 30338-3157
(870) 284-4029
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN712951
GA
225700000X
Massage Therapist
Primary
6977
AR
225700000X
Massage Therapist
Primary
MT0011476
GA
Other
Enumeration date
06/02/2011
Last updated
03/30/2026
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