Provider Demographics
NPI:1922649722
Name:MARINER, ALEXIS (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MARINER
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 1:2206 PEACHFORD CIR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6482
Mailing Address - Country:US
Mailing Address - Phone:954-478-7176
Mailing Address - Fax:
Practice Address - Street 1:3001 HEMBREE RD NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4205
Practice Address - Country:US
Practice Address - Phone:954-478-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer