Anthony Taylor Pack, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2715 Issued in AL

Practice address

700 Pelham Rd N
Jacksonville, AL 36265-1602

Phone

(256) 782-5582

Fax

(256) 782-8515

NPI assigned

Jul 17, 2023

Last updated

Jul 17, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1013696095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 PELHAM RD N",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362651602",
            "telephone_number": "256-782-5582",
            "fax_number": "256-782-8515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 PELHAM RD N",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362651602",
            "telephone_number": "256-782-5582",
            "fax_number": "256-782-8515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "405 Arlington Meadows Dr",
            "address_purpose": "LOCATION",
            "city": "Fisherville",
            "state": "KY",
            "postal_code": "400237734",
            "country_code": "US",
            "telephone_number": "502-418-4386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACK",
        "first_name": "ANTHONY",
        "middle_name": "TAYLOR",
        "credential": "ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-17",
        "last_updated": "2023-07-17",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AL",
            "license": "2715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Jacksonville, AL
• Providers in Jacksonville, AL by specialty
• Athletic Trainer in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.