Provider Demographics
NPI:1619167608
Name:USSERY, TIMOTHY ROLLINS (ATC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROLLINS
Last Name:USSERY
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 1:16741 HWY 67 SOUTH
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461
Mailing Address - Country:US
Mailing Address - Phone:912-681-2500
Mailing Address - Fax:912-681-2200
Practice Address - Street 1:16741 HWY 67 SOUTH
Practice Address - Street 2:SUITE 1-A
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30461
Practice Address - Country:US
Practice Address - Phone:912-681-2500
Practice Address - Fax:912-681-2200
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0007552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer