=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245571421
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOE LANE PATTERSON M.S. ,ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2013
-----------------------------------------------------
Last Update Date | 03/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2115 DOUGLAS DR
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36203-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-689-2986
-----------------------------------------------------
Fax | 256-820-8554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2115 DOUGLAS DR
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36203-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-689-2986
-----------------------------------------------------
Fax | 256-820-8554
-----------------------------------------------------
=====================================================
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 | 257
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------