Provider Demographics
NPI:1447065024
Name:MCGLOTHEN, VANESSA (LMT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MCGLOTHEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 BARRETT LAKES BLVD NW APT 1015
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7532
Mailing Address - Country:US
Mailing Address - Phone:405-206-4091
Mailing Address - Fax:
Practice Address - Street 1:3133 MAPLE DR NE STE 120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2509
Practice Address - Country:US
Practice Address - Phone:404-220-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014694225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist