NPI 1841470473

Jared M Luke, MEDATCLAT

Practitioner Athletic Trainer Villa Rica, GA

Practice location

Address: 256 Raleigh Way, Villa Rica, GA 30180-7020
Phone: (678) 787-9291

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence AT001443 (GA)

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Registry record

NPI: 1841470473
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 Nov 2007
Record last updated: 5 Jun 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.