Individual
MR. ROB ANTONIO DICKS SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, ATC, LAT
Contact information
Practice address
601 BROAD ST, LAGRANGE, GA 30240-2955
(706) 880-8099
Mailing address
601 BROAD ST, LAGRANGE, GA 30240-2999
(706) 880-8099
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT000919
GA
Other
Enumeration date
07/10/2006
Last updated
12/13/2021
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