Healthcare Provider Details

I. General information

NPI: 1134385958
Provider Name (Legal Business Name): DAVID MICHAEL KLOEHS A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3739 WHITE SANDS WAY
SUWANEE GA
30024-7429
US

IV. Provider business mailing address

3739 WHITE SANDS WAY
SUWANEE GA
30024-7429
US

V. Phone/Fax

Practice location:
  • Phone: 678-357-0738
  • Fax:
Mailing address:
  • Phone: 678-357-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT000897
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: