Provider Demographics
NPI:1245408608
Name:RAYMOND, ASHLEY DAWN (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 DEERING RD NW
Mailing Address - Street 2:APT. 6310
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2293
Mailing Address - Country:US
Mailing Address - Phone:607-423-4460
Mailing Address - Fax:
Practice Address - Street 1:125 DECATUR ST SE
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3201
Practice Address - Country:US
Practice Address - Phone:607-423-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0014472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer