Individual
TOVAN WILLEY ELMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
900 GARDEN MEADOWS CT, LOGANVILLE, GA 30052-8986
(516) 417-4832
Mailing address
900 GARDEN MEADOWS CT, LOGANVILLE, GA 30052-8986
(516) 417-4832
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1659
GA
Other
Enumeration date
08/13/2009
Last updated
05/15/2014
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