Individual
CAROLYN T DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT NCTMB SET
Contact information
Practice address
1130 HURRICANE SHOALS RD NE, SUITE 1900, LAWRENCEVILLE, GA 30043-4851
(678) 462-2972
Mailing address
582 MACKENZIE CT, DACULA, GA 30019-2385
(678) 462-2972
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT001114
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008002671
GWINNETT COUNTY BUSINESS LICENSE
GA
01
—
538877-07
NATIONAL CERTIFICATION OF THERAPEUTIC MASSAGE & BODYWORK
—
01
—
MT001114
MASSAGE LICENSE
GA
Enumeration date
03/05/2010
Last updated
03/01/2011
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