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General NPI Number Information
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NPI Number | 1275840639
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Entity Type | Individual
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Provider Name | AMY C MUSSELMAN ATC
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Gender | Female
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 01/16/2012
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Provider Practice Location Address
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Address Line | 2045 PEACHTREE RD NE
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City | ATLANTA
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State | GA
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Zip | 30309-1414
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Country | US
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Telephone | 678-732-1332
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Fax | 404-425-1622
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Provider Business Mailing Address
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Address Line | 11024 PERIMETER TRCE E
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City | ATLANTA
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State | GA
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Zip | 30346-1931
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Country | US
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Telephone | 678-732-1332
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 11-1114
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT001793
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License Number State | GA
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