Healthcare Provider Details

I. General information

NPI: 1013473362
Provider Name (Legal Business Name): MR. AUSTIN TYLER ALBRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 KEITH ST NW STE 205
CLEVELAND TN
37312-4326
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 235-590-4444
  • Fax:
Mailing address:
  • Phone: 423-836-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2513
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: