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General NPI Number Information
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NPI Number | 1962477869
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Entity Type | Individual
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Provider Name | JOHN LAFAYETTE GAINES A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 1794 S BETHEL RD STE C
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City | DECATUR
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State | AL
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Zip | 35603-5410
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Country | US
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Telephone | 254-391-4223
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Fax |
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Provider Business Mailing Address
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Address Line | 71 PARTRIDGE RD
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City | DECATUR
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State | AL
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Zip | 35603-6018
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Country | US
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Telephone | 325-439-1422
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Fax | 254-442-5100
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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 | AT1903
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License Number State | TX
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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 | 1021
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License Number State | AL
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