Healthcare Provider Details

I. General information

NPI: 1053377358
Provider Name (Legal Business Name): LINDA JANE HUFFMYER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 PARKWOOD DR
BRUNSWICK GA
31520-4722
US

IV. Provider business mailing address

305 HALLOWES DR E
SAINT MARYS GA
31558-2922
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-7000
  • Fax:
Mailing address:
  • Phone: 912-576-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT000937
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: