Provider Demographics
NPI:1316117120
Name:HALLMAN, AMY NICOLE (ATC/LAT, MS)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NICOLE
Last Name:HALLMAN
Suffix:
Gender:F
Credentials:ATC/LAT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 FOG RD NE
Mailing Address - Street 2:
Mailing Address - City:RANGER
Mailing Address - State:GA
Mailing Address - Zip Code:30735
Mailing Address - Country:US
Mailing Address - Phone:770-548-2084
Mailing Address - Fax:
Practice Address - Street 1:365 FOG RD NE
Practice Address - Street 2:
Practice Address - City:RESACA
Practice Address - State:GA
Practice Address - Zip Code:30735
Practice Address - Country:US
Practice Address - Phone:770-548-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0014742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer