Healthcare Provider Details

I. General information

NPI: 1205208659
Provider Name (Legal Business Name): JOHN HUFFINES L/ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 HARDIN AVE
COLLEGE PARK GA
30337-2132
US

IV. Provider business mailing address

1555 HARDIN AVE
COLLEGE PARK GA
30337-2132
US

V. Phone/Fax

Practice location:
  • Phone: 404-345-2377
  • Fax:
Mailing address:
  • Phone: 404-345-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002781
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: