Individual
TAZ HUNTER KICKLIGHTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
7300 REINHARDT COLLEGE CIR, WALESKA, GA 30183-2981
(770) 720-9226
(770) 720-5622
Mailing address
7455 SALMON LN., OOLTEWAH, TN 37363-5530
(770) 862-0494
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
628
GA
Other
Enumeration date
07/08/2009
Last updated
07/08/2009
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