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NPI Code Detail

MEDICARE: JIMMY L BATTE PTA

MEDICARE: JIMMY L BATTE PTA
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
1174400000XSpecialist2068SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12068OTHERSCSTATE LICENSE

General Provider Information

NPI Number : 1629128251
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIMMY L BATTE PTA
Provider Business Mailing Address
First Line : 943 PINE LOG RD.
Second Line :
City : WARRENVILLE
State : SC
Zip : 29851
Country : US
Telephone Number : 803-649-9797
Fax Number :
Provider Business Practice Location Address
First Line : 943 PINE LOG RD
Second Line :
City : AIKEN
State : SC
Zip : 29803-7330
Country : US
Telephone Number : 803-649-9797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 10/28/2015

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Directions to “ JIMMY L BATTE PTA” Practice Location

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