Provider Demographics
NPI:1497116503
Name:GERMAIN, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GERMAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4695 N CHURCH LN SE
Mailing Address - Street 2:APT 12207
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-1545
Mailing Address - Country:US
Mailing Address - Phone:727-648-0188
Mailing Address - Fax:
Practice Address - Street 1:26 EAGLE ROW NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1019
Practice Address - Country:US
Practice Address - Phone:407-727-6714
Practice Address - Fax:407-727-9599
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0027202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer