MEDICARE: JOHNNY TRAN MAT, LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT004619	GA

General Provider Information

NPI Number	:	1326803024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNY TRAN MAT, LAT, ATC

Provider Business Mailing Address
First Line	:	472 JOHN STEWART PL
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-2652
Country	:	US
Telephone Number	:	678-756-7137
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 E MAIN ST
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-2775
Country	:	US
Telephone Number	:	404-938-7629
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2024
Last Update Date	:	06/09/2026

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