Individual
COLLIN BLAKE FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
3005 SARDIS RD, GAINESVILLE, GA 30506-2232
(912) 294-7908
Mailing address
76 HORSERANGE VISTA CT, CLEVELAND, GA 30528-2387
(912) 294-7908
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT003432
GA
Other
Enumeration date
10/30/2018
Last updated
10/30/2018
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