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General NPI Number Information
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NPI Number | 1710023528
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Entity Type | Individual
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Provider Name | LYDIA VANDERFORD ADKINS MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 1496 HUDSON BRIDGE RD
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5018
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Country | US
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Telephone | 404-414-6269
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Fax | 404-785-4165
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Provider Business Mailing Address
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Address Line | 429 EGLINGTON TRL
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City | LOCUST GROVE
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State | GA
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Zip | 30248-7012
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Country | US
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Telephone | 404-375-1587
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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 | AT000760
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License Number State | GA
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