Active NPI
Shelby Woodall
- Massage Therapist
- Smyrna, GA
National Provider Identifier
1912438110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT011771
- Practice address
- 1154 Concord Rd SE
Smyrna, GA 30080-4263 - Phone
- (770) 855-0679
- NPI assigned
- Mar 21, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT-23019 | AZ | |
| Massage Therapist | 225700000X | MT011771 | GA | Primary |
Addresses
Primary practice location
1154 Concord Rd SE
Smyrna, GA 30080-4263
Mailing address
728 Woodmont Dr
Marietta, GA 30062-3833
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 |
|---|---|---|---|
| MT-23019 | AZ | MD | Massage Therapist |
| MT011771 | GA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574467200000",
"number": "1912438110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "728 WOODMONT DR",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300623833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1154 CONCORD RD SE",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300804263",
"telephone_number": "770-855-0679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODALL",
"first_name": "SHELBY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-21",
"last_updated": "2019-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AZ",
"license": "MT-23019",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "GA",
"license": "MT011771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smyrna, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.