=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134527476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYSON ENGLAND ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2014
-----------------------------------------------------
Last Update Date | 12/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 COGSWELL AVE
-----------------------------------------------------
City | PELL CITY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35125-1397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-338-2250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 249 BROWN HILL RD
-----------------------------------------------------
City | STEELE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35987-2808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-594-1026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 928
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------