Provider Demographics
NPI:1730657024
Name:MCCRIRIE, PAIGE CONSTANCE (ATC)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:CONSTANCE
Last Name:MCCRIRIE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 NOBLE CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1092
Mailing Address - Country:US
Mailing Address - Phone:517-817-8737
Mailing Address - Fax:
Practice Address - Street 1:4484 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2797
Practice Address - Country:US
Practice Address - Phone:404-364-8434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0035152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer