Individual
MACKENZIE RYLEE MODICA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2206 COLONY DR, CANTON, GA 30114-4522
(770) 820-9548
Mailing address
2206 COLONY DR, CANTON, GA 30114-4522
(770) 820-9548
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/07/2026
Last updated
01/07/2026
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