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MR. ROBERT CARLOS AVILA ATC, LAT
Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1235505066
Individual Registrant:MR. ROBERT CARLOS AVILA ATC, LAT
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
5265 WARD ST SE SMYRNA, GA 30080-1944 US
Tel: 770-331-9925 Fax: --
Tel: 770-331-9925 Fax: --
Contact information for business:
2013 PARADOR BND MCDONOUGH, GA 30253-9058 US
Tel: 770-331-9925 Fax: --
Tel: 770-331-9925 Fax: --
Registration Information:
NPI: 1235505066
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Athletic Trainer | GA | AT002748 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
