Individual
BRIDGETTE IDETTE BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MAT, LAT, ATC
Contact information
Practice address
111 HICKORY KNOLL DR APT 401, CANTON, GA 30114-2444
(616) 773-9018
Mailing address
111 HICKORY KNOLL DR APT 401, CANTON, GA 30114-2444
(616) 773-9018
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT003286
GA
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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