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General NPI Number Information
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NPI Number | 1407263791
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Entity Type | Individual
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Provider Name | MARY ELIZABETH NORMAN ATC, LAT, CHES, BLSI
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Gender | Female
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 1220 W WHEELER PKWY STE B
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City | AUGUSTA
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State | GA
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Zip | 30909-1895
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Country | US
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Telephone | 706-721-5249
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Fax | 706-446-4951
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Provider Business Mailing Address
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Address Line | 2609 DUBLIN DR
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City | AUGUSTA
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State | GA
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Zip | 30906-9596
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Country | US
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Telephone | 864-314-2661
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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 | 1437
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License Number State | SC
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