Active NPI
Jordan Teboda, ATC
- Athletic Trainer
- Atlanta, GA
National Provider Identifier
1245693209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT002448
- Practice address
- 59 Executive Park S
Atlanta, GA 30329-2208 - Phone
- (404) 778-6330
- Fax
- (404) 778-6370
- NPI assigned
- Mar 29, 2016
- 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 | AT002448 | GA | Primary |
Addresses
Primary practice location
59 Executive Park S
Atlanta, GA 30329-2208
Mailing address
8259 Wicker Ave
Saint John, IN 46373-8878
Phone (219) 365-6560
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT002448 | GA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459209600000",
"number": "1245693209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8259 WICKER AVE",
"city": "SAINT JOHN",
"state": "IN",
"postal_code": "463738878",
"telephone_number": "219-365-6560",
"fax_number": "219-365-6561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "59 EXECUTIVE PARK S",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303292208",
"telephone_number": "404-778-6330",
"fax_number": "404-778-6370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEBODA",
"first_name": "JORDAN",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-29",
"last_updated": "2016-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "AT002448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.