Active NPI
Andrew Wilson
- Athletic Trainer
- Chattanooga, TN
National Provider Identifier
1003302126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 615 McCallie Ave
Chattanooga, TN 37403 - Phone
- (423) 425-4111
- NPI assigned
- Jul 2, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
615 McCallie Ave
Chattanooga, TN 37403
Mailing address
975 E 3Rd St # 260
Chattanooga, TN 37403-2173
Phone (423) 778-9008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640563200000",
"number": "1003302126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "975 E 3RD ST # 260",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374032173",
"telephone_number": "423-778-9008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 MCCALLIE AVE",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "37403",
"telephone_number": "423-425-4111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ANDREW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-02",
"last_updated": "2021-12-27",
"certification_date": "2021-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.