Provider Demographics
NPI:1972221901
Name:ATKINSON, SANDER CLARK (ATC)
Entity type:Individual
Prefix:
First Name:SANDER
Middle Name:CLARK
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-5801
Mailing Address - Country:US
Mailing Address - Phone:601-479-3907
Mailing Address - Fax:
Practice Address - Street 1:910 HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5801
Practice Address - Country:US
Practice Address - Phone:601-479-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT01512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer