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General NPI Number Information
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NPI Number | 1225430523
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Entity Type | Individual
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Provider Name | NICHOLAS SPARACIO ATC
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Gender | Male
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 205 LANIER DR
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City | STATESBORO
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State | GA
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Zip | 30458-1524
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Country | US
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Telephone | 912-478-1001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8082 STATESBORO GA 30460 ATHLETIC TRAINING ROOM
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City | STATESBORO
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State | GA
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Zip | 30460-0001
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Country | US
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Telephone |
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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 | 1854
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT002542
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License Number State | GA
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