Shajuan Virgil, C.PED., LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT001526 Issued in GA

Practice address

108 Baytree Dr
Thomasville, GA 31792-8861

Phone

(678) 682-4493

NPI assigned

Jan 18, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1610928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610928000000",
    "number": "1649869264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2428",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301020008",
            "telephone_number": "678-682-4493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 BAYTREE DR",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317928861",
            "telephone_number": "678-682-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIRGIL",
        "first_name": "SHAJUAN",
        "credential": "C.PED., LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-18",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "GA",
            "license": "CPED4585",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "GA",
            "license": "MT001526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Thomasville, GA
• Massage Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; 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.