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General NPI Number Information
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NPI Number | 1063627412
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Entity Type | Individual
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Provider Name | VARA YVONNE HITCHCOCK ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1120 MORNINGSIDE DR
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City | PERRY
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State | GA
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Zip | 31069-2906
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Country | US
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Telephone | 478-256-1912
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Fax | 478-988-1613
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Provider Business Mailing Address
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Address Line | 105 HUNTER CT
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City | MACON
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State | GA
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Zip | 31210-2169
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Country | US
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Telephone | 478-477-7325
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000240
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License Number State | GA
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