Healthcare Provider Details

I. General information

NPI: 1114673043
Provider Name (Legal Business Name): ALEXANDER ADEN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 UNION UNIVERSITY DR
JACKSON TN
38305-3697
US

IV. Provider business mailing address

156 MAYWOOD DR
JACKSON TN
38305-2856
US

V. Phone/Fax

Practice location:
  • Phone: 731-661-6591
  • Fax:
Mailing address:
  • Phone: 731-225-9520
  • 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: