Active NPI
Charles Alan Wardlaw, ATC
- Athletic Trainer
- Junction City, AR
National Provider Identifier
1316474885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 694
- Practice address
- 100 W Holly Rd
Junction City, AR 71749-9031 - Phone
- (870) 924-4575
- NPI assigned
- May 16, 2017
- Last updated
- May 16, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 694 | AR | Primary |
Addresses
Primary practice location
100 W Holly Rd
Junction City, AR 71749-9031
Mailing address
PO Box 269
Junction City, AR 71749-0269
Phone (870) 403-4648
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 694 | AR | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Junction City School | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Local Education Agency (LEA)
- Junction City, AR
- NPI 1861569519
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494892800000",
"number": "1316474885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 269",
"city": "JUNCTION CITY",
"state": "AR",
"postal_code": "717490269",
"telephone_number": "870-403-4648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 W HOLLY RD",
"city": "JUNCTION CITY",
"state": "AR",
"postal_code": "717499031",
"telephone_number": "870-924-4575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARDLAW",
"first_name": "CHARLES",
"middle_name": "ALAN",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-16",
"last_updated": "2017-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AR",
"license": "694",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Junction City, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.