Individual
URIYAH A MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
2449 STAGECOACH RD, OGLETHORPE, GA 31068-8425
(478) 555-5555
Mailing address
61 SHERRI LN, TIFTON, GA 31794-9452
(229) 733-2878
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000036522
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16788
INDUSTRIAL
—
Enumeration date
04/28/2020
Last updated
11/21/2022
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