Provider Demographics
NPI:1700604220
Name:ADAMS, CHELSEA ILLISSA (MS, LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:ILLISSA
Last Name:ADAMS
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 1:6755 GREENBOWER LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-4981
Mailing Address - Country:US
Mailing Address - Phone:678-628-2634
Mailing Address - Fax:
Practice Address - Street 1:6755 GREENBOWER LN
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-4981
Practice Address - Country:US
Practice Address - Phone:678-628-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0031062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer