Provider Demographics
NPI:1124818356
Name:SUTTON, AIDAN CAMPBELL (ATC)
Entity type:Individual
Prefix:
First Name:AIDAN
Middle Name:CAMPBELL
Last Name:SUTTON
Suffix:
Gender:
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 RALEIGH LAGRANGE DR
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38066-3433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 RALEIGH LAGRANGE DR
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38066-3433
Practice Address - Country:US
Practice Address - Phone:901-651-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer