Individual
JACK WINN MANSFIELD SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
6569 CUMBERLAND GAP PKWY, HARROGATE, TN 37752-8015
(423) 869-6322
Mailing address
331 COLWYN AVE, PO BOX 213, CUMBERLAND GAP, TN 37724
(423) 869-0802
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0000001015
TN
Other
Enumeration date
06/27/2006
Last updated
07/08/2007
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