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1770050536
COLLIN BLAKE FREDERICK
GAINESVILLE, GA
NPI
1770050536
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: GA AT003432)
Enumeration Date
2018-10-30
Last Update Date
2018-10-30
Business Address
COLLIN BLAKE FREDERICK LAT, ATC
3005 SARDIS RD
GAINESVILLE, GA 30506-2232
Phone number: 912-294-7908
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Mailing Address
COLLIN BLAKE FREDERICK LAT, ATC
76 HORSERANGE VISTA CT
CLEVELAND, GA 30528-2387
Phone number: 912-294-7908
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