Healthcare Provider Details

I. General information

NPI: 1841790201
Provider Name (Legal Business Name): STEPHEN J HAJDAS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8160 VETERANS PKWY APT 1224
COLUMBUS GA
31909-1963
US

IV. Provider business mailing address

8160 VETERANS PKWY APT 1224
COLUMBUS GA
31909-1963
US

V. Phone/Fax

Practice location:
  • Phone: 848-333-6373
  • Fax:
Mailing address:
  • Phone: 848-333-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002718
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: