MEDICARE: AARON RICE ATC

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	AT002379	GA

General Provider Information

NPI Number	:	1619351731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON RICE ATC

Provider Business Mailing Address
First Line	:	5375 SUGARLOAF PKWY
Second Line	:	APT 7107
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-5767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5375 SUGARLOAF PKWY
Second Line	:	APT 7107
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-5767
Country	:	US
Telephone Number	:	207-400-6375
Fax Number	:

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

Provider Enumeration Date	:	07/18/2015
Last Update Date	:	07/18/2015

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