Healthcare Provider Details

I. General information

NPI: 1154672061
Provider Name (Legal Business Name): LESLIE ANNE ALVAREZ ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 MUNDY MILL RD STE 102B
GAINESVILLE GA
30504-8226
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 770-287-8821
  • Fax: 770-287-8797
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002168
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: