Provider Demographics
NPI:1912267071
Name:MENDENCE, ANDREA S (MED, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:S
Last Name:MENDENCE
Suffix:
Gender:F
Credentials:MED, 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:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:706-235-2727
Mailing Address - Fax:706-235-2726
Practice Address - Street 1:304 SHORTER AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4289
Practice Address - Country:US
Practice Address - Phone:706-509-3446
Practice Address - Fax:706-235-2726
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
GA0708021042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer