Healthcare Provider Details

I. General information

NPI: 1801323068
Provider Name (Legal Business Name): MONICA LYNN BURRUSS CARNEY LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 POPLAR SPRINGS RD
RINGGOLD GA
30736-5811
US

IV. Provider business mailing address

6206 WIMBERLY DR
CHATTANOOGA TN
37416-3229
US

V. Phone/Fax

Practice location:
  • Phone: 256-874-8194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: