Healthcare Provider Details

I. General information

NPI: 1083746366
Provider Name (Legal Business Name): DAVID S CIGANEK M.S., A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 DEERING RD NW
ATLANTA GA
30309-2203
US

IV. Provider business mailing address

291 DEERING RD NW
ATLANTA GA
30309-2203
US

V. Phone/Fax

Practice location:
  • Phone: 800-555-1212
  • Fax:
Mailing address:
  • Phone: 800-555-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT000279
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: