Active NPI
Brian Douglas Walters, LMT
- Massage Therapist
- Stone Mountain, GA
National Provider Identifier
1427425347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT007445
- Practice address
- 2045 Rockbridge Rd
Stone Mountain, GA 30087-3551 - Phone
- (678) 883-2873
- NPI assigned
- Aug 26, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT007445 | GA | Primary |
Addresses
Primary practice location
2045 Rockbridge Rd
Stone Mountain, GA 30087-3551
Mailing address
4018 Sue LN
Decatur, GA 30035-1075
Phone (404) 438-4477
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT007445 | GA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440547200000",
"number": "1427425347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4018 SUE LN",
"city": "DECATUR",
"state": "GA",
"postal_code": "300351075",
"telephone_number": "404-438-4477",
"fax_number": "800-975-1805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2045 ROCKBRIDGE RD",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300873551",
"telephone_number": "678-883-2873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "BRIAN",
"middle_name": "DOUGLAS",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-26",
"last_updated": "2015-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "GA",
"license": "MT007445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stone Mountain, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.