Provider Demographics
NPI:1154955631
Name:CRONEY, CARLENE (LMT, CPT)
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:CRONEY
Suffix:
Gender:F
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 POST ROAD LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2246
Mailing Address - Country:US
Mailing Address - Phone:678-531-9964
Mailing Address - Fax:
Practice Address - Street 1:3002 KINGSTON CT SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8957
Practice Address - Country:US
Practice Address - Phone:678-531-9964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT007355225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist