Icenogle, Mark R.
Icenogle, Mark R. is an individual health care provider with primary practice located at 758 Old Norcross Rd , Lawrenceville GA 30045-3385. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as his primary health care specialty. Icenogle, Mark R. can be contacted via phone (678) 985-7190.Contact Information
Primary practice address
758 Old Norcross Rd
Lawrenceville GA 30045-3385
Phone: (678) 985-7190
Fax: (678) 985-7158
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer | 2255A2300X | AT001236 | Georgia |
Profile Details
| NPI number | 1306800610 |
|---|---|
| LBN Legal business name | Icenogle, Mark R. |
| Credentials | AT-C |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 13th, 2006 |
| Last updated | Apr 8th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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