Provider Demographics
NPI:1942237656
Name:ANDERSON, DAVID BRIAN (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRIAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27015 HIGHWAY 430 S
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-9421
Mailing Address - Country:US
Mailing Address - Phone:601-664-8185
Mailing Address - Fax:
Practice Address - Street 1:27015 HIGHWAY 430 S
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-9421
Practice Address - Country:US
Practice Address - Phone:601-664-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT03572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSAT0357OtherMS LIC. NUMBER