Provider Demographics
NPI:1710023528
Name:ADKINS, LYDIA VANDERFORD (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:VANDERFORD
Last Name:ADKINS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 EGLINGTON TRL
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-7012
Mailing Address - Country:US
Mailing Address - Phone:404-375-1587
Mailing Address - Fax:
Practice Address - Street 1:1496 HUDSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5018
Practice Address - Country:US
Practice Address - Phone:404-414-6269
Practice Address - Fax:404-785-4165
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0007602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer