Provider Demographics
NPI:1841790201
Name:HAJDAS, STEPHEN J (ATC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:HAJDAS
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 1:8160 VETERANS PKWY APT 1224
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1963
Mailing Address - Country:US
Mailing Address - Phone:848-333-6373
Mailing Address - Fax:
Practice Address - Street 1:8160 VETERANS PKWY APT 1224
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1963
Practice Address - Country:US
Practice Address - Phone:848-333-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0027182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer