MEDICARE: MS. JILLIAN MICHELLE MCELROY MS, ATC/L

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	AT740	TN

General Provider Information

NPI Number	:	1811099856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILLIAN MICHELLE MCELROY MS, ATC/L

Provider Business Mailing Address
First Line	:	223 SLAYDEN CIR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-4334
Country	:	US
Telephone Number	:	615-513-1384
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 HAYNES ST
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-4547
Country	:	US
Telephone Number	:	931-906-4170
Fax Number	:	931-906-4173

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2007

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