Provider Demographics
NPI:1366240210
Name:NUNNERY, DESTINY
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:NUNNERY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BEECH CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-3790
Mailing Address - Country:US
Mailing Address - Phone:564-229-9151
Mailing Address - Fax:
Practice Address - Street 1:76 BEECH CREEK CIR
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-3790
Practice Address - Country:US
Practice Address - Phone:564-229-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT015273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist