Provider Demographics
NPI:1750869871
Name:LONAS, MARI ELIZABETH (LAT, ATC)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:ELIZABETH
Last Name:LONAS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:ELIZABETH
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 OCONEE RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4241
Mailing Address - Country:US
Mailing Address - Phone:678-633-1496
Mailing Address - Fax:
Practice Address - Street 1:1270 HIGHWAY 29 N
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1128
Practice Address - Country:US
Practice Address - Phone:678-633-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0034072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer