MEDICARE: ASHLEY DAWN RAYMOND ATC, CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT001447	GA

General Provider Information

NPI Number	:	1245408608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY DAWN RAYMOND ATC, CSCS

Provider Business Mailing Address
First Line	:	302 DEERING RD NW
Second Line	:	APT. 6310
City	:	ATLANTA
State	:	GA
Zip	:	30309-2293
Country	:	US
Telephone Number	:	607-423-4460
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 DECATUR ST SE
Second Line	:	SUITE 201
City	:	ATLANTA
State	:	GA
Zip	:	30303-3201
Country	:	US
Telephone Number	:	607-423-4460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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