Individual
MICHAEL MINICOZZI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
95 DUKE LN, KATHLEEN, GA 31047-3201
(478) 456-5019
Mailing address
95 DUKE LN, KATHLEEN, GA 31047-3201
(478) 456-5019
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT000952
GA
Other
Enumeration date
05/05/2020
Last updated
05/05/2020
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