MEDICARE: MR. JASON ZAJAC ATC

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
1	2255A2300X	Athletic Trainer	566	AL

General Provider Information

NPI Number	:	1518231265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON ZAJAC ATC

Provider Business Mailing Address
First Line	:	4700 JAGUAR DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-4678
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 JAGUAR DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-4678
Country	:	US
Telephone Number	:	205-439-1400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/27/2012

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