Basic Information
| Provider Information | |||||||||
| NPI: | 1487783684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKHAM | ||||||||
| FirstName: | LANCE | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7493 HOOPER CV | ||||||||
| Address2: | |||||||||
| City: | YOUNG HARRIS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305822017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063799619 | ||||||||
| FaxNumber: | 7063794593 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | YOUNG HARRIS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063795199 | ||||||||
| FaxNumber: | 7063794593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT000805 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.