Healthcare Provider Details

I. General information

NPI: 1659919264
Provider Name (Legal Business Name): ERIC ALEXANDER KURE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 TOWNE PARK DR STE 400
RINCON GA
31326-5153
US

IV. Provider business mailing address

11900 WHITE BLUFF RD APT 1708
SAVANNAH GA
31419-1541
US

V. Phone/Fax

Practice location:
  • Phone: 912-826-3797
  • Fax:
Mailing address:
  • Phone: 678-849-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT003179
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: