Individual
GINA C LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
332 JETTA LN, CANTON, GA 30115-8614
(678) 787-7473
Mailing address
332 JETTA LN, CANTON, GA 30115-8614
(678) 787-7473
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT003167
GA
Other
Enumeration date
10/01/2019
Last updated
10/01/2019
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