Individual
KELLIE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
709 ALLEN DR, VIDALIA, GA 30474-6348
(912) 373-2568
Mailing address
709 ALLEN DR, VIDALIA, GA 30474-6348
(912) 373-2568
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
09/06/2021
Last updated
09/06/2021
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