Melissa J Gambrill

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT014009 Issued in GA

Practice address

114 12TH St W Ste F
Tifton, GA 31794-6976

Phone

(229) 402-7833

NPI assigned

Aug 17, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Awaken Wellness, LLC

  • Acupuncturist
  • Columbia, MD
  • NPI 1073814851

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1083380489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 12TH ST W STE F",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317946976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 12TH ST W STE F",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317946976",
            "telephone_number": "229-402-7833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7130 Minstrel Way Ste 160",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MD",
            "postal_code": "210455336",
            "country_code": "US",
            "telephone_number": "410-227-2687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAMBRILL",
        "first_name": "MELISSA",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-17",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "MD",
            "license": "R02510",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "GA",
            "license": "MT014009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Melissa@awakenwellness.com",
            "affiliation": "Y",
            "endpointDescription": "Email",
            "affiliationName": "Awaken Wellness, LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "useOtherDescription": "Email",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7130 Minstrel Way Ste 160",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210455336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Courtlyn Christanna Fussell, RPH
• G.R.C. Inc.
• Donna B Galliano, NP-C
• Enrique Galliano, MD
• Peter J Gambino, D.O.
• Jennifer Ganas, M.ED.,CCC-SLP
• Thomas Ganas, PT
• Rebecca B Gaskins, NP
• Laurie J Gautney, C.R.N.P.
• Ivy Gay

• Massage Therapist in Tifton, GA
• Providers in Tifton, GA by specialty
• Massage Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; 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.