Provider Demographics
NPI:1932207057
Name:KROHN, DOUGLAS LEE (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:LEE
Last Name:KROHN
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 GRAVITT TRL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6915
Mailing Address - Country:US
Mailing Address - Phone:770-476-2080
Mailing Address - Fax:
Practice Address - Street 1:2907 GRAVITT TRL
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6915
Practice Address - Country:US
Practice Address - Phone:770-476-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0001162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer