Active NPI
Timmy Jay Agan, M.S., A.T.,C.
- Athletic Trainer
- Cave Spring, GA
National Provider Identifier
1225229156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 000077
- Practice address
- 306 Rehoboth Rd SW
Cave Spring, GA 30124-2974 - Phone
- (770) 877-1016
- Fax
- (770) 382-8883
- NPI assigned
- Aug 6, 2007
- Last updated
- Aug 6, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 000077 | GA | Primary |
Addresses
Primary practice location
306 Rehoboth Rd SW
Cave Spring, GA 30124-2974
Mailing address
306 Rehoboth Rd SW
Cave Spring, GA 30124-2974
Phone (770) 877-1016
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000077 | Other | GA | GEORGIA BOARD OF ATHLETIC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000077 | GA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186358400000",
"number": "1225229156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 REHOBOTH RD SW",
"city": "CAVE SPRING",
"state": "GA",
"postal_code": "301242974",
"telephone_number": "770-877-1016",
"fax_number": "770-382-8883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 REHOBOTH RD SW",
"city": "CAVE SPRING",
"state": "GA",
"postal_code": "301242974",
"telephone_number": "770-877-1016",
"fax_number": "770-382-8883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGAN",
"first_name": "TIMMY",
"middle_name": "JAY",
"name_prefix": "Mr.",
"credential": "M.S., A.T.,C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-06",
"last_updated": "2007-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "000077",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA BOARD OF ATHLETIC",
"identifier": "0000077",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cave Spring, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.