MEDICARE: MR. JULIO CESAR LLANOS JR. 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
1	2255A2300X	Athletic Trainer	AT000780	GA

General Provider Information

NPI Number	:	1770812547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JULIO CESAR LLANOS JR. ATC

Provider Business Mailing Address
First Line	:	1117 LAURELWOOD RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-2019
Country	:	US
Telephone Number	:	706-593-0633
Fax Number	:	706-569-3435

Provider Business Practice Location Address
First Line	:	4225 UNIVERSITY AVE
Second Line	:	ATTN: JULIO LLANOS - ATHLETICS
City	:	COLUMBUS
State	:	GA
Zip	:	31907-5679
Country	:	US
Telephone Number	:	706-565-4332
Fax Number	:	706-569-3435

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

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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