Mark R. Icenogle, AT-C
Mark R. Icenogle, AT-C is an Athletic Trainer in Lawrenceville, Georgia. Licensed in Georgia. Registered with an NPI since 2006.
- Licensed in
- GA
- In the registry since
- 2006
Practice location Address checks out
758 Old Norcross RdLawrenceville, GA 30045-3385
Phone: (678) 985-7190
Fax: (678) 985-7158
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Athletic Trainer (primary) | Taxonomy 2255A2300X · Licence AT001236 (GA) |
|---|
Record details
| NPI number | 1306800610 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | AT-C |
| Sole proprietor | No |
| NPI enumerated | April 13, 2006 |
| Last updated in NPPES | April 8, 2008 |
| Mailing address | 758 Old Norcross Rd, Lawrenceville, GA 30045-3385 |
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