Provider Demographics
NPI:1932563178
Name:SIKES, MARY CATHERINE (MED, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:SIKES
Suffix:
Gender:F
Credentials:MED, 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:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064-0231
Mailing Address - Country:US
Mailing Address - Phone:478-955-0352
Mailing Address - Fax:
Practice Address - Street 1:126 HWY 212 WEST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064
Practice Address - Country:US
Practice Address - Phone:478-955-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0025502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer