Individual
MADELINE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
32 OLD STONEMILL RD NE, MARIETTA, GA 30067-4128
(404) 402-0364
Mailing address
32 OLD STONEMILL RD NE, MARIETTA, GA 30067-4128
(404) 402-0364
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/09/2018
Last updated
09/09/2018
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