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NPI Code Detail

MEDICARE: MR. PAUL P HIGGS ATC, LAT

MEDICARE: MR. PAUL P HIGGS ATC, LAT
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
12255A2300XAthletic Trainer140GA

General Provider Information

NPI Number : 1912979543
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAUL P HIGGS ATC, LAT
Provider Business Mailing Address
First Line : 4524 SAN SABA DR
Second Line :
City : HAHIRA
State : GA
Zip : 31632-2606
Country : US
Telephone Number : 229-245-4380
Fax Number :
Provider Business Practice Location Address
First Line : 2525 N PATTERSON ST
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-1735
Country : US
Telephone Number : 229-253-2889
Fax Number : 229-259-5129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 07/26/2019

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