Individual
LOGAN SHANE TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
102 CENTER PARK LN, ATHENS, GA 30605-4294
(229) 375-2426
Mailing address
380 PICCADILLY SQ, ATHENS, GA 30605-3044
(229) 375-2426
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/17/2019
Last updated
07/10/2021
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