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General NPI Number Information
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NPI Number | 1295479053
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Entity Type | Individual
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Provider Name | TAYLOR J MCCREDIE ATC
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Gender | Male
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 9075 HOLCOMB DR
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City | FORT BENNING
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State | GA
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Zip | 31905-4928
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Country | US
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Telephone | 518-925-0831
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 LEE ROAD 51 LOT 67
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City | AUBURN
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State | AL
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Zip | 36832-6530
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Country | US
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Telephone | 518-925-0831
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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 | AT004576
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License Number State | GA
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