Provider Demographics
NPI:1407263791
Name:NORMAN, MARY ELIZABETH (ATC, LAT, CHES, BLSI)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:NORMAN
Suffix:
Gender:F
Credentials:ATC, LAT, CHES, BLSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 DUBLIN DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-9596
Mailing Address - Country:US
Mailing Address - Phone:864-314-2661
Mailing Address - Fax:
Practice Address - Street 1:1220 W WHEELER PKWY STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1895
Practice Address - Country:US
Practice Address - Phone:706-721-5249
Practice Address - Fax:706-446-4951
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer