Provider Demographics
NPI:1255519500
Name:DEMALINE, CHRIS HOWARD (ATC)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:HOWARD
Last Name:DEMALINE
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 1:2831 TRAILING IVY WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7631
Mailing Address - Country:US
Mailing Address - Phone:770-932-7775
Mailing Address - Fax:
Practice Address - Street 1:2831 TRAILING IVY WAY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7631
Practice Address - Country:US
Practice Address - Phone:770-932-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0005362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer