Individual
MARCUS A UNDERWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
123 VININGS PKWY SE, SMYRNA, GA 30080-3863
(678) 523-1547
Mailing address
123 VININGS PKWY SE, SMYRNA, GA 30080-3863
(678) 523-1547
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT002377
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT002377
GEORGIA SECRETARY OF STATE
GA
01
—
BOC217903
BOARD OF CERTIFICATION
—
Enumeration date
04/09/2019
Last updated
04/09/2019
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