Healthcare Provider Details

I. General information

NPI: 1497084297
Provider Name (Legal Business Name): JARED SALVATORE SANDLER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 UNIVERSITY AVE ATTN: ATHLETICS
COLUMBUS GA
31907-5679
US

IV. Provider business mailing address

1 COLLEGE STREET
YOUNG HARRIS GA
30582
US

V. Phone/Fax

Practice location:
  • Phone: 706-565-4332
  • Fax: 706-569-3435
Mailing address:
  • Phone: 706-379-5191
  • Fax: 706-379-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001327
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: