Scott William Gardner, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT1119 Issued in SC

Practice address

438 Killian Ave
Attn: Ohws Group
Shaw Afb, SC 29152

Phone

(803) 895-3719

NPI assigned

Feb 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1043282916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 SAUSAGE LN",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291702462",
            "telephone_number": "803-586-4944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 KILLIAN AVE",
            "address_2": "ATTN: OHWS GROUP",
            "city": "SHAW AFB",
            "state": "SC",
            "postal_code": "29152",
            "telephone_number": "803-895-3719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "SCOTT",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "SC",
            "license": "AT1119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL",
            "identifier": "AT1119",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Faith Wellness Factory LLC
• Leslie Marie Filler, DNP, APRN, FNP-BC
• Angelique Stacey Ann Forrester, MD
• Nathaniel Frisch, PA
• Bryan J Funke, MD, MPH
• Jeffrey D Geddes, PH.D.
• Erica Gerring, LISW-CP
• Brian E. Gray, D.P.T.
• Kristie Lynette Griffin, LCSW, LISW CP
• Julie Griffith, M.D.

• All providers in Shaw Afb, SC
• Athletic Trainer in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.