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NPI Code Detail

MEDICARE: DR. JUSTIN A ADEYEMI ATC, LAT

MEDICARE: DR. JUSTIN A ADEYEMI ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1255980173
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN A ADEYEMI ATC, LAT
Provider Business Mailing Address
First Line : 310 OLD OAK RD
Second Line :
City : MACON
State : GA
Zip : 31216-5695
Country : US
Telephone Number : 678-485-9575
Fax Number :
Provider Business Practice Location Address
First Line : 231 W HANCOCK ST
Second Line :
City : MILLEDGEVILLE
State : GA
Zip : 31061-3371
Country : US
Telephone Number : 678-485-9575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2019
Last Update Date : 09/04/2019

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