MEDICARE: LEWIS EARL MCCARTY JR. ATC, NREMT-I, OTC

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		GA

General Provider Information

NPI Number	:	1427088707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEWIS EARL MCCARTY JR. ATC, NREMT-I, OTC

Provider Business Mailing Address
First Line	:	150 OAK RIDGE PL
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-5018
Country	:	US
Telephone Number	:	404-975-7933
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 OAK RIDGE PL
Second Line	:	10 P
City	:	GREENVILLE
State	:	SC
Zip	:	29615-5018
Country	:	US
Telephone Number	:	404-975-7933
Fax Number	:

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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