Individual
MR. TIMMY JAY AGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., A.T.,C.
Contact information
Practice address
306 REHOBOTH RD SW, CAVE SPRING, GA 30124-2974
(770) 877-1016
(770) 382-8883
Mailing address
306 REHOBOTH RD SW, CAVE SPRING, GA 30124-2974
(770) 877-1016
(770) 382-8883
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000077
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000077
GEORGIA BOARD OF ATHLETIC
GA
Enumeration date
08/06/2007
Last updated
08/06/2007
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