Individual
JUAN ANTONIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1021 CENTRAL AVE, DEMOREST, GA 30535-5252
(706) 778-8500
Mailing address
3716 BOLDING CIR, FLOWERY BRANCH, GA 30542-3054
(770) 561-3206
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/22/2025
Last updated
05/22/2025
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