Active NPI
Shameka Gullatt
- Massage Therapist
- Buford, GA
National Provider Identifier
1699216259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT001306
- Practice address
- 4749 Nelson Brogdon Blvd
BLD 100 Suite 4
Buford, GA 30518-7513 - Phone
- (470) 769-0054
- NPI assigned
- Mar 15, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Reflexologist | 173C00000X | MT001306 | GA | |
| Massage Therapist | 225700000X | MT001306 | GA | Primary |
Addresses
Primary practice location
4749 Nelson Brogdon Blvd
BLD 100 Suite 4
Buford, GA 30518-7513
Mailing address
4749 Nelson Brogdon Blvd
BLD 100 Suite 4
Buford, GA 30518-7513
Phone (470) 769-0054
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 |
|---|---|---|---|
| MT001306 | GA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489536000000",
"number": "1699216259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4749 NELSON BROGDON BLVD",
"address_2": "BLD 100 SUITE 4",
"city": "BUFORD",
"state": "GA",
"postal_code": "305187513",
"telephone_number": "470-769-0054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4749 NELSON BROGDON BLVD",
"address_2": "BLD 100 SUITE 4",
"city": "BUFORD",
"state": "GA",
"postal_code": "305187513",
"telephone_number": "470-769-0054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GULLATT",
"first_name": "SHAMEKA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-15",
"last_updated": "2017-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "173C00000X",
"taxonomy_group": "",
"desc": "Reflexologist",
"state": "GA",
"license": "MT001306",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "GA",
"license": "MT001306",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buford, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.