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General NPI Number Information
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NPI Number | 1730657024
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Entity Type | Individual
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Provider Name | PAIGE CONSTANCE MCCRIRIE ATC
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Gender | Female
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 4484 PEACHTREE RD NE
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City | BROOKHAVEN
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State | GA
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Zip | 30319-2797
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Country | US
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Telephone | 404-364-8434
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Fax |
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Provider Business Mailing Address
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Address Line | 302 NOBLE CREEK DR NW
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City | ATLANTA
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State | GA
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Zip | 30327-1092
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Country | US
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Telephone | 517-817-8737
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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 | AT003515
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License Number State | GA
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