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General NPI Number Information
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NPI Number | 1811042658
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Entity Type | Individual
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Provider Name | D MARTIN SCRUGGS II ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5900 WALNUT GROVE RD
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City | MEMPHIS
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State | TN
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Zip | 38120-2104
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Country | US
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Telephone | 901-261-4960
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Fax |
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Provider Business Mailing Address
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Address Line | 277 BOULDINCREST AVE
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City | COLLIERVILLE
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State | TN
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Zip | 38017-6882
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Country | US
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Telephone | 901-861-6434
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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 | 282
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License Number State | TN
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