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General NPI Number Information
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NPI Number | 1225315047
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Entity Type | Individual
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Provider Name | TIMOTHY LYNN ATKINSON ATC
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Gender | Male
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 700 BULLDOG DR
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City | WHITE HALL
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State | AR
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Zip | 71602-9563
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Country | US
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Telephone | 870-794-5570
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 DEERWOOD DR
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City | WHITE HALL
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State | AR
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Zip | 71602-9218
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Country | US
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Telephone | 870-692-5849
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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 | AT170
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License Number State | AR
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