Provider Demographics
NPI:1447638945
Name:GENERALLY, NATALIE (LPMT, MT-BC, MMED)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:GENERALLY
Suffix:
Gender:F
Credentials:LPMT, MT-BC, MMED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1494
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-8008
Mailing Address - Country:US
Mailing Address - Phone:404-446-6945
Mailing Address - Fax:
Practice Address - Street 1:101 DEVANT ST
Practice Address - Street 2:SUITE 703
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2710
Practice Address - Country:US
Practice Address - Phone:404-446-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMUT000067225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist