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General NPI Number Information
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NPI Number | 1831999119
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Entity Type | Individual
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Provider Name | COLE SAMUEL EAKIN MATRN, ATC
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Gender | Male
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1332 SOUTHERN DR
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City | STATESBORO
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State | GA
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Zip | 30460-1360
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Country | US
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Telephone | 912-478-4636
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Fax |
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Provider Business Mailing Address
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Address Line | 130 BRIARWOOD RD # 130
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City | STATESBORO
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State | GA
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Zip | 30458-2459
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Country | US
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Telephone | 503-333-6734
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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 | PENDING
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License Number State | GA
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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 | AL7022
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License Number State | FL
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