MEDICARE: MS. LEAH MICHELLE GAITHER 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	AT001248	GA

General Provider Information

NPI Number	:	1871538173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEAH MICHELLE GAITHER ATC

Provider Business Mailing Address
First Line	:	2115 COLUMNS DR
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-5956
Country	:	US
Telephone Number	:	404-374-6273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3640 MUNDY MILL RD
Second Line	:	STE. 102B
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-8218
Country	:	US
Telephone Number	:	770-287-8821
Fax Number	:	770-287-8797

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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