Healthcare Provider Details

I. General information

NPI: 1992848337
Provider Name (Legal Business Name): JEREMY DANIEL ATKINS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E OAKLEY PARK RD
COMMERCE TOWNSHIP MI
48390-5509
US

IV. Provider business mailing address

12853 DIXIE
REDFORD MI
48239-2601
US

V. Phone/Fax

Practice location:
  • Phone: 248-672-0106
  • Fax:
Mailing address:
  • Phone: 248-763-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: