MDJ Massage LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

Legal business name

MDJ MASSAGE LLC

Practice address

4017 Grey Oak Dr
Valdosta, GA 31605-5865

Phone

(229) 262-8008

Fax

(229) 232-4743

NPI assigned

Jul 5, 2020

Organization subpart

No

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

Authorized official

Name

Maryellyn Noriega, LMT NCTMB

Title

Owner/Licensed Massage Therapist

Phone

(229) 262-8008

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1593907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596672000000",
    "number": "1649897786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4017 GREY OAK DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316055865",
            "telephone_number": "229-262-8008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4017 GREY OAK DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316055865",
            "telephone_number": "229-262-8008",
            "fax_number": "229-232-4743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDJ MASSAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-05",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "NORIEGA",
        "authorized_official_first_name": "MARYELLYN",
        "authorized_official_title_or_position": "OWNER/LICENSED MASSAGE THERAPIST",
        "authorized_official_telephone_number": "229-262-8008",
        "authorized_official_credential": "LMT NCTMB"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; 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.