Provider Demographics
NPI:1912979543
Name:HIGGS, PAUL P (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:P
Last Name:HIGGS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 SAN SABA DR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-2606
Mailing Address - Country:US
Mailing Address - Phone:229-245-4380
Mailing Address - Fax:
Practice Address - Street 1:2525 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1735
Practice Address - Country:US
Practice Address - Phone:229-253-2889
Practice Address - Fax:229-259-5129
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer