MEDICARE: CHRIS EUGENE HAM A.T.C

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

General Provider Information

NPI Number	:	1881657690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRIS EUGENE HAM A.T.C

Provider Business Mailing Address
First Line	:	802 CLUB PKWY
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-1934
Country	:	US
Telephone Number	:	615-604-8177
Fax Number	:	615-460-5456

Provider Business Practice Location Address
First Line	:	1900 BELMONT BLVD
Second Line	:	SPORTS MEDICINE
City	:	NASHVILLE
State	:	TN
Zip	:	37212-3758
Country	:	US
Telephone Number	:	615-460-8020
Fax Number	:	615-460-5456

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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