Scott William Gardner, ATC
Specialist/Technologist, Athletic Trainer in Shaw Afb, SC. Individual provider (NPI-1).
NPI number1043282916
StatusActive
Last updated in NPPESMay 1, 2023
Details
- NPI
- 1043282916
- Entity type
- Individual (NPI-1)
- Name
- Mr. Scott William Gardner
- Credential
- ATC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 6, 2006
- Certification date
- May 1, 2023
- Last updated
- May 1, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | AT1119 | SC | Yes |
Practice location
438 Killian AveAttn: Ohws Group
Shaw Afb, SC 29152
Phone 803-895-3719
Mailing address
119 Sausage LnWest Columbia, SC 29170-2462
Phone 803-586-4944
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