Provider Demographics
NPI:1992365209
Name:MCNAMARA, LANCE JOSEPH (EMT-I, ATC/L)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:JOSEPH
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:EMT-I, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 N FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-4501
Mailing Address - Country:US
Mailing Address - Phone:770-867-4519
Mailing Address - Fax:
Practice Address - Street 1:272 N FIFTH AVE
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-4501
Practice Address - Country:US
Practice Address - Phone:770-867-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0010482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty