Active NPI
Taz Hunter Kicklighter, MS, ATC
- Athletic Trainer
- Waleska, GA
National Provider Identifier
1629207964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 628
- Practice address
- 7300 Reinhardt College Cir
Waleska, GA 30183-2981 - Phone
- (770) 720-9226
- Fax
- (770) 720-5622
- NPI assigned
- Jul 8, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 | 628 | GA | Primary |
Addresses
Primary practice location
7300 Reinhardt College Cir
Waleska, GA 30183-2981
Mailing address
7455 Salmon LN.
Ooltewah, TN 37363-5530
Phone (770) 862-0494
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 |
|---|---|---|---|
| 628 | GA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247011200000",
"number": "1629207964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7455 SALMON LN.",
"city": "OOLTEWAH",
"state": "TN",
"postal_code": "373635530",
"telephone_number": "770-862-0494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7300 REINHARDT COLLEGE CIR",
"city": "WALESKA",
"state": "GA",
"postal_code": "301832981",
"telephone_number": "770-720-9226",
"fax_number": "770-720-5622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KICKLIGHTER",
"first_name": "TAZ",
"middle_name": "HUNTER",
"credential": "MS, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-08",
"last_updated": "2009-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "628",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waleska, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.