Provider Demographics
NPI:1194009829
Name:SILVERA, COURTNEY ANNE (ATC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANNE
Last Name:SILVERA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 TALKING LEAVES CT
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-1918
Mailing Address - Country:US
Mailing Address - Phone:407-341-1369
Mailing Address - Fax:
Practice Address - Street 1:1590 BILL MURDOCK RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5999
Practice Address - Country:US
Practice Address - Phone:770-578-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0019672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer