MEDICARE: APRIL GREEN ATC

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
1	2255A2300X	Athletic Trainer	AT0329	MS

General Provider Information

NPI Number	:	1104850254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL GREEN ATC

Provider Business Mailing Address
First Line	:	710 CATALPA ST
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-3118
Country	:	US
Telephone Number	:	662-902-1456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 HOSPITAL DR
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-7202
Country	:	US
Telephone Number	:	662-902-1456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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Directions to “ APRIL GREEN ATC” Practice Location

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