Provider Demographics
NPI:1972028561
Name:ADDISON, LUNDON KAY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LUNDON
Middle Name:KAY
Last Name:ADDISON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:LUNDON
Other - Middle Name:KAY
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:2059 OLD HWY 197 S
Mailing Address - Street 2:
Mailing Address - City:MT. AIRY
Mailing Address - State:GA
Mailing Address - Zip Code:30563
Mailing Address - Country:US
Mailing Address - Phone:470-246-7680
Mailing Address - Fax:
Practice Address - Street 1:2059 OLD HWY 197 S
Practice Address - Street 2:
Practice Address - City:MT. AIRY
Practice Address - State:GA
Practice Address - Zip Code:30563
Practice Address - Country:US
Practice Address - Phone:706-778-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0033322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer