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NPI Code Detail

MEDICARE: PROF. KELLY JO LUMPKIN ATC

MEDICARE: PROF. KELLY JO LUMPKIN 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
12081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician0000000155TN

General Provider Information

NPI Number : 1700300571
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. KELLY JO LUMPKIN ATC
Provider Business Mailing Address
First Line : 306 LIBERTY VIEW LN
Second Line :
City : LYNCHBURG
State : VA
Zip : 24502-2291
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 306 LIBERTY VIEW LN
Second Line :
City : LYNCHBURG
State : VA
Zip : 24502-2291
Country : US
Telephone Number : 423-284-0005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2017
Last Update Date : 08/02/2017

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Directions to “ PROF. KELLY JO LUMPKIN ATC” Practice Location

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