Herman Anderson, LMT

Key facts

NPI

1104663541

Entity type

Individual (NPI type 1)

Primary specialty

Massage Therapist 225700000X

License

MT013780 (GA)

Practice address

1205 Johnson Ferry Rd Ste 126
Marietta, GA 30068-5401

Phone

(678) 213-2368

NPI assigned

Jul 12, 2024

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 12, 2024.

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1104663541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3669 PEACHTREE RD NE APT 3B",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303191251",
            "telephone_number": "678-449-7936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 JOHNSON FERRY RD STE 126",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300685401",
            "telephone_number": "678-213-2368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "HERMAN",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-12",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "GA",
            "license": "MT013780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

• Brianne Hunter Anderson, MD
• Charles R Anderson, M.D.
• Christopher Dale Anderson, DC
• Christopher Michael Anderson, DMD
• Cynthia Anderson, LMT
• James David Anderson, DMD
• Julie Anderson, D.C.
• Kesley Anderson, RN
• Lance Christian Anderson
• Melissa Anderson, MSN, FNP-C

All providers in Marietta, GA · Massage Therapist in Georgia