Individual
MAKAYLA FORREST MANGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
3590 BRASELTON HWY STE 102, DACULA, GA 30019-1120
(770) 271-1488
(770) 271-1822
Mailing address
5334 BIRCHLAND CT, BUFORD, GA 30518-9027
(678) 761-2643
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT003303
GA
Other
Enumeration date
03/15/2021
Last updated
03/15/2021
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