Healthcare Provider Details

I. General information

NPI: 1588018352
Provider Name (Legal Business Name): JOSHUA REMY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 UNIVERSITY AVE ATHLETICS DEPT
COLUMBUS GA
31907-5679
US

IV. Provider business mailing address

2150 STADIUM DR APT B5
PHENIX CITY AL
36867-3113
US

V. Phone/Fax

Practice location:
  • Phone: 706-507-8297
  • Fax:
Mailing address:
  • Phone: 706-662-7547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002248
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: