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General NPI Number Information
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NPI Number | 1396264701
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Entity Type | Individual
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Provider Name | TYLER WACK MS, ATC
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Gender | Male
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 01/31/2026
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Provider Practice Location Address
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Address Line | 2150 DISCOVERY DR
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City | APPLING
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State | GA
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Zip | 30802-0078
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Country | US
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Telephone | 888-280-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 4377 ROXBURY DR
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City | EVANS
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State | GA
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Zip | 30809-3249
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Country | US
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Telephone | 803-457-3722
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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 |
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License Number State |
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