Healthcare Provider Details

I. General information

NPI: 1417985607
Provider Name (Legal Business Name): MARVIN TRINKAUS II ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DECATUR ST, SE
ATLANTA GA
30303-3201
US

IV. Provider business mailing address

895 SINGING HILLS DR
ROSWELL GA
30076-1700
US

V. Phone/Fax

Practice location:
  • Phone: 404-651-3172
  • Fax: 404-463-9659
Mailing address:
  • Phone: 678-461-6192
  • Fax: 404-463-9659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT000646
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: