Provider Demographics
NPI:1275840639
Name:MUSSELMAN, AMY C (ATC)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:C
Last Name:MUSSELMAN
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 1:11024 PERIMETER TRCE E
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1931
Mailing Address - Country:US
Mailing Address - Phone:678-732-1332
Mailing Address - Fax:
Practice Address - Street 1:2045 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1414
Practice Address - Country:US
Practice Address - Phone:678-732-1332
Practice Address - Fax:404-425-1622
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11-1114246ZS0410X
GAAT0017932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer