MEDICARE: JEFFREY J PARR PHD, 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
1	2255A2300X	Athletic Trainer	AL1663	FL
2	2255A2300X	Athletic Trainer	AT0837	MS

General Provider Information

NPI Number	:	1194790212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY J PARR PHD, ATC, LAT

Provider Business Mailing Address
First Line	:	155 CROSS CREEK PKWY APT 334
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-4424
Country	:	US
Telephone Number	:	352-262-2498
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 COLLEGE DR
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39406-7500
Country	:	US
Telephone Number	:	601-266-6321
Fax Number	:

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	05/10/2018

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