Provider Demographics
NPI:1972874923
Name:CAIN, MARY SPENCER (ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:SPENCER
Last Name:CAIN
Suffix:
Gender:F
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 1:2850 DELK RD SE
Mailing Address - Street 2:APT 35-C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5352
Mailing Address - Country:US
Mailing Address - Phone:704-813-5895
Mailing Address - Fax:
Practice Address - Street 1:700 COBB PKWY N
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2404
Practice Address - Country:US
Practice Address - Phone:770-427-2689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0018932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer