MEDICARE: MS. AMY CLAIRE GRIFFITH MS, ATC/L, CSCS

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	AT001155	GA

General Provider Information

NPI Number	:	1598792392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY CLAIRE GRIFFITH MS, ATC/L, CSCS

Provider Business Mailing Address
First Line	:	1552 BARTLEY RD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30240-8307
Country	:	US
Telephone Number	:	706-302-3990
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 WHITFIELD RD
Second Line	:
City	:	HOGANSVILLE
State	:	GA
Zip	:	30230-3209
Country	:	US
Telephone Number	:	706-845-2070
Fax Number	:

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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