MEDICARE: STEPHEN J HAJDAS 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	AT002718	GA

General Provider Information

NPI Number	:	1841790201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN J HAJDAS ATC

Provider Business Mailing Address
First Line	:	8160 VETERANS PKWY APT 1224
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-1963
Country	:	US
Telephone Number	:	848-333-6373
Fax Number	:

Provider Business Practice Location Address
First Line	:	8160 VETERANS PKWY APT 1224
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-1963
Country	:	US
Telephone Number	:	848-333-6373
Fax Number	:

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

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	02/12/2018

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