Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mark R. Icenogle, AT-C

Individual provider Athletic Trainer · NPI 1306800610

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 Rd
Lawrenceville, GA 30045-3385
Phone: (678) 985-7190
Fax: (678) 985-7158
Show map & directions

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 number1306800610
Entity typeIndividual (Type 1)
GenderMale
Credentials AT-C
Sole proprietorNo
NPI enumeratedApril 13, 2006
Last updated in NPPESApril 8, 2008
Mailing address758 Old Norcross Rd, Lawrenceville, GA 30045-3385

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