Individual
KOKI IKEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1501 MERCER UNIVERSITY DR, MACON, GA 31207-1515
(209) 355-7806
Mailing address
296 ORANGE ST APT 5, MACON, GA 31201-1688
(209) 355-7806
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/01/2021
Last updated
08/01/2021
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