Mystic Massage

Primary specialty

SpecialistTaxonomy code 174400000X

License

MT000319 Issued in GA

Legal business name

MYSTIC MASSAGE

Practice address

8725 Roswell Rd
Atlanta, GA 30350-7533

Phone

(404) 914-1822

NPI assigned

Jun 27, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anna Lee Goode, LMT

Title

Owner/Operator

Phone

(404) 914-1822

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1003078387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2408 SUMMERLAKE DR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303503054",
            "telephone_number": "404-914-1822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8725 ROSWELL RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303507533",
            "telephone_number": "404-914-1822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC MASSAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-27",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "GOODE",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "404-914-1822",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "MT000319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendrick Myles
• Rebecca I Myles, PA
• Candace L Mynatt, CPNP
• Jhon Kelly Myrtil
• Danielle Nicole Mysore, LCSW
• Mystic Medical, LLC
• Leslie Myszka, P.T.
• MZ Vaccine LLC
• N. Gail McLaurin, DMD, PC
• Hammad S. N'Cho, PH.D.

• Specialist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.