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NPI Code Detail

MEDICARE: MR. JEFFREY LYNN PORTER MA,ATC,LAT

MEDICARE: MR. JEFFREY LYNN PORTER MA,ATC,LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1033261813
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY LYNN PORTER MA,ATC,LAT
Provider Business Mailing Address
First Line : 755 HANK AARON DR SW
Second Line :
City : ATLANTA
State : GA
Zip : 30315-1120
Country : US
Telephone Number : 404-614-1376
Fax Number : 404-614-1549
Provider Business Practice Location Address
First Line : 755 HANK AARON DR SW
Second Line :
City : ATLANTA
State : GA
Zip : 30315-1120
Country : US
Telephone Number : 404-614-1376
Fax Number : 404-614-1549
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 07/08/2007

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