Healthcare Provider Details

I. General information

NPI: 1578624649
Provider Name (Legal Business Name): TONY F. BARNETT JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 FIELD HOUSE ALL-AMERICAN DRIVE
UNIVERSITY MS
38677-1848
US

IV. Provider business mailing address

1055 PINE ST APT 262
NASHVILLE TN
37203-4092
US

V. Phone/Fax

Practice location:
  • Phone: 662-915-7536
  • Fax: 662-915-5275
Mailing address:
  • Phone: 615-483-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1656
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: