Provider Demographics
NPI:1427568245
Name:TERRELL, ANDRIENNE IGNATIA (MA LAT ATC)
Entity Type:Individual
Prefix:MISS
First Name:ANDRIENNE
Middle Name:IGNATIA
Last Name:TERRELL
Suffix:
Gender:F
Credentials:MA LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 CROWN LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8717
Mailing Address - Country:US
Mailing Address - Phone:678-314-9484
Mailing Address - Fax:
Practice Address - Street 1:600 N TERMINAL HARTSFIELD-JACKSON AIRPORT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30337
Practice Address - Country:US
Practice Address - Phone:404-773-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0032012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer