Individual
JIMMY LEE FAIRFAX JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC LAT
Contact information
Practice address
14315 SW 106TH CT, MIAMI, FL 33176-7032
(484) 529-8037
Mailing address
14315 SW 106TH CT, MIAMI, FL 33176-7032
(484) 529-8037
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL2413
FL
Other
Enumeration date
01/08/2019
Last updated
01/08/2019
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