MEDICARE: ADRIENNE J FAIRCLOTH 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	A0000784	MD
2	2255A2300X	Athletic Trainer	AT23000049	DC

General Provider Information

NPI Number	:	1952767212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE J FAIRCLOTH ATC

Provider Business Mailing Address
First Line	:	4665 BLUE PLAINS DR SW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-5202
Country	:	US
Telephone Number	:	202-528-8273
Fax Number	:

Provider Business Practice Location Address
First Line	:	4665 BLUE PLAINS DR SW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-5202
Country	:	US
Telephone Number	:	202-528-8273
Fax Number	:

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

Provider Enumeration Date	:	01/01/2016
Last Update Date	:	04/03/2026

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