Mary L Przekwas, ATC

Key facts

NPI

1649658154

Entity type

Individual (NPI type 1)

Primary specialty

Athletic Trainer 2255A2300X

License

AT003170 (GA)

Practice address

2277 Martha Berry Hwy NW
Mount Berry, GA 30149-9707

Phone

(706) 232-5374

NPI assigned

May 16, 2015

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1431734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1649658154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "743 VIOLET CIR",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605409225",
            "telephone_number": "630-544-8950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2277 MARTHA BERRY HWY NW",
            "city": "MOUNT BERRY",
            "state": "GA",
            "postal_code": "301499707",
            "telephone_number": "706-232-5374"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "743 Violet Cir",
            "address_purpose": "LOCATION",
            "city": "Naperville",
            "state": "IL",
            "postal_code": "605409225",
            "country_code": "US",
            "telephone_number": "630-544-8950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRZEKWAS",
        "first_name": "MARY",
        "middle_name": "L",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT003170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Berry, GA

• Sarah Beth Berry, ATC
• Melissa Bown, ATC

All providers in Mount Berry, GA · Athletic Trainer in Georgia