Provider Demographics
NPI:1548391063
Name:LAGOW, DAVID (ATC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:LAGOW
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ASBURY CIR
Mailing Address - Street 2:WOODRUFF PE CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1006
Mailing Address - Country:US
Mailing Address - Phone:404-727-5613
Mailing Address - Fax:404-712-4415
Practice Address - Street 1:600 ASBURY CIR
Practice Address - Street 2:WOODRUFF PE CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1006
Practice Address - Country:US
Practice Address - Phone:404-727-5613
Practice Address - Fax:404-712-4415
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0013032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer