Individual
KELLY MOONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC/L
Contact information
Practice address
104 WATERFORD CIR, LAGRANGE, GA 30240-7565
(706) 957-5158
Mailing address
104 WATERFORD CIR, LAGRANGE, GA 30240-7565
(706) 957-5158
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/30/2014
Last updated
07/30/2014
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