Active NPI
Keisha Monique Gwinn, MT
- Massage Therapist
- Atlanta, GA
National Provider Identifier
1770808545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT004320
- Practice address
- 2221 Peachtree Rd NE
Ste. P33
Atlanta, GA 30309-1148 - Phone
- (404) 955-1000
- NPI assigned
- Apr 5, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT004320 | GA | Primary |
Addresses
Primary practice location
2221 Peachtree Rd NE
Ste. P33
Atlanta, GA 30309-1148
Mailing address
220 26TH St NW
Apt. 1117
Atlanta, GA 30309-1914
Phone (404) 955-1000
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT004320 | GA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Opulent Wellness LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270425600000",
"number": "1770808545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 26TH ST NW",
"address_2": "APT. 1117",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303091914",
"telephone_number": "404-955-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2221 PEACHTREE RD NE",
"address_2": "STE. P33",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303091148",
"telephone_number": "404-955-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWINN",
"first_name": "KEISHA",
"middle_name": "MONIQUE",
"name_prefix": "Mrs.",
"credential": "MT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-05",
"last_updated": "2010-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "GA",
"license": "MT004320",
"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 Apr 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.