Provider Demographics
NPI:1275087785
Name:HULL, TROY ROYAL (MS, LAT, ATC, OTC)
Entity Type:Individual
Prefix:MRS
First Name:TROY
Middle Name:ROYAL
Last Name:HULL
Suffix:
Gender:F
Credentials:MS, LAT, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 ROSEMAN TRL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2860 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6287
Practice Address - Country:US
Practice Address - Phone:910-305-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0037942255A2300X
20-0605246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000025515OtherBOARD OF CERTIFICATION FOR ATHLETIC TRAINING
GAAT003794OtherGEORGIA BOARD OF ATHLETIC TRAINERS
20-0605OtherNATIONAL BOARD FOR CERTIFICATION OF ORTHOPAEDIC TECHNOLOGISTS