Individual
MISS CRYSTAL V SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1005 STATE UNIVERSITY DR, DEPARTMENT OF ATHLETICS, FORT VALLEY, GA 31030-4313
(478) 825-6195
(478) 825-6886
Mailing address
111 POND DR, KATHLEEN, GA 31047-3202
(478) 987-2754
(478) 987-2749
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001359
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
ATHLETIC TRAINER
GA
Enumeration date
03/21/2007
Last updated
02/21/2008
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