Provider Demographics
NPI:1740601855
Name:BETHEA, ANDREW (ATC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:BETHEA
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 1:2659 ABUTMENT RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-4887
Mailing Address - Country:US
Mailing Address - Phone:706-532-6700
Mailing Address - Fax:706-532-6760
Practice Address - Street 1:2659 ABUTMENT RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4887
Practice Address - Country:US
Practice Address - Phone:706-532-6700
Practice Address - Fax:706-532-6760
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT002369225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner