Individual
NYSA FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
516 DRAYTON ST, SAVANNAH, GA 31401-5651
(808) 499-9586
Mailing address
516 DRAYTON ST, SAVANNAH, GA 31401-5651
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
269
HI
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
08/30/2016
Last updated
02/23/2023
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