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General NPI Number Information
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NPI Number | 1124233374
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Entity Type | Individual
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Provider Name | JIMMIE SUE SASSER ATC
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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 | 07/16/2007
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Provider Practice Location Address
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Address Line | 1235 JASMINE RD
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City | DUBLIN
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State | GA
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Zip | 31021-0841
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Country | US
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Telephone | 912-583-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 129 SOUTH RAILROAD AVENUE POST OFFICE BOX 411
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City | MT. VERNON
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State | GA
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Zip | 30445
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Country | US
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Telephone | 912-583-2020
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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 | AT 000352
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License Number State | GA
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