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General NPI Number Information
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NPI Number | 1275185332
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Entity Type | Individual
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Provider Name | MADISON PAIGE ESTES LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 755 HIGHWAY 293
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City | EMERSON
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State | GA
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Zip | 30137-2204
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Country | US
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Telephone | 404-263-0495
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Fax |
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Provider Business Mailing Address
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Address Line | 4265 TAYLORS WOOD DR
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City | CUMMING
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State | GA
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Zip | 30028-8954
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Country | US
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Telephone | 678-458-5983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT003664
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License Number State | GA
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