Provider Demographics
NPI:1962477869
Name:GAINES, JOHN LAFAYETTE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LAFAYETTE
Last Name:GAINES
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 1:71 PARTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-6018
Mailing Address - Country:US
Mailing Address - Phone:325-439-1422
Mailing Address - Fax:254-442-5100
Practice Address - Street 1:1794 S BETHEL RD STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-5410
Practice Address - Country:US
Practice Address - Phone:254-391-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT19032255A2300X
AL10212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer