Provider Demographics
NPI:1104882372
Name:PIRCHIO, ANTHONY GUS JR (MED, ATC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:GUS
Last Name:PIRCHIO
Suffix:JR
Gender:M
Credentials:MED, ATC
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Mailing Address - Street 1:165 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3731
Mailing Address - Country:US
Mailing Address - Phone:706-613-9827
Mailing Address - Fax:706-542-7707
Practice Address - Street 1:100 SMITH ST
Practice Address - Street 2:STEGEMAN COLISEUM
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1505
Practice Address - Country:US
Practice Address - Phone:706-542-6521
Practice Address - Fax:706-542-7707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GAAT0009992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA22OtherATHLETIC TRAINER