Active NPI
Andrew Blair Dacres, LMT
- Massage Therapist
- Atlanta, GA
National Provider Identifier
1720329295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT006007
- Practice address
- 3300 N E Expy NE Ste C
Atlanta, GA 30341-3932 - Phone
- (770) 500-3848
- Fax
- (678) 868-1114
- NPI assigned
- Mar 8, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 | MT006007 | GA | Primary |
Addresses
Primary practice location
3300 N E Expy NE Ste C
Atlanta, GA 30341-3932
Mailing address
3629 Linecrest TRL
Ellenwood, GA 30294-1972
Phone (770) 334-0818
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 |
|---|---|---|---|
| MT006007 | GA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362700800000",
"number": "1720329295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3629 LINECREST TRL",
"city": "ELLENWOOD",
"state": "GA",
"postal_code": "302941972",
"telephone_number": "770-334-0818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 N E EXPY NE STE C",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303413932",
"telephone_number": "770-500-3848",
"fax_number": "678-868-1114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DACRES",
"first_name": "ANDREW",
"middle_name": "BLAIR",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-03-08",
"last_updated": "2013-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "GA",
"license": "MT006007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.