Individual
DONNA DECKARD-BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, MED
Contact information
Practice address
100 PERIMETER RD, CLEMSON, SC 29634-0001
(864) 656-1951
(864) 656-6408
Mailing address
PO BOX 31, CLEMSON, SC 29633-0031
(864) 656-1951
(864) 656-6408
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
83
SC
Other
Enumeration date
09/26/2007
Last updated
09/26/2007
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