Healthcare Provider Details

I. General information

NPI: 1629587084
Provider Name (Legal Business Name): CLINTON MICHAEL BIGGS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814-3216
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 615-553-4546
  • Fax: 615-553-4794
Mailing address:
  • Phone: 423-238-8930
  • Fax: 423-254-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5963
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: