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General NPI Number Information
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NPI Number | 1992437248
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Entity Type | Individual
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Provider Name | LOUIS ALONZO MADDEN ATC
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Gender | Male
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 1400 S GERMANTOWN RD
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City | GERMANTOWN
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State | TN
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Zip | 38138-2205
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Country | US
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Telephone | 901-759-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 5999 SUMMER TRACE DR APT 308
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City | MEMPHIS
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State | TN
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Zip | 38134-6829
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Country | US
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Telephone | 901-287-9829
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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 | 1718
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License Number State | TN
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