Provider Demographics
NPI:1760110795
Name:ROLLINS, DOROTHY MICHAELA (ATC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MICHAELA
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 WOODLANDS DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2495
Mailing Address - Country:US
Mailing Address - Phone:316-734-9111
Mailing Address - Fax:
Practice Address - Street 1:1269 BARCLAY CIR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2903
Practice Address - Country:US
Practice Address - Phone:770-426-2770
Practice Address - Fax:678-322-1144
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0042192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer