Individual
MRS. ASHLEY VANCE KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1014 SYCAMORE DR, STE B, DECATUR, GA 30030-1644
(404) 299-1700
(404) 299-1616
Mailing address
2664 GLENROSE HL, ATLANTA, GA 30341-5784
(404) 520-8674
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT000597
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT000597
STATE LICENSE
GA
Enumeration date
11/03/2006
Last updated
07/08/2007
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