Healthcare Provider Details

I. General information

NPI: 1548294051
Provider Name (Legal Business Name): SHANNA MCFARLAND GRUBBS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF WEST ALABAMA STATION 14
LIVINGSTON AL
35470
US

IV. Provider business mailing address

PO BOX 307
LIVINGSTON AL
35470-0307
US

V. Phone/Fax

Practice location:
  • Phone: 205-652-3450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number837
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: