Active NPI
Jacob Wagner, ATC
- Athletic Trainer
- Thomasville, NC
National Provider Identifier
1598498362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2336
- Practice address
- 211 Old Lexington Rd
Thomasville, NC 27360-3428 - Phone
- (704) 576-9298
- NPI assigned
- Jul 7, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2336 | NC | Primary |
Addresses
Primary practice location
211 Old Lexington Rd
Thomasville, NC 27360-3428
Mailing address
474 Stratford Rd
Lexington, NC 27292-9653
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2336 | Other | NC | NCBATE LICENSE |
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 |
|---|---|---|---|
| 2336 | NC | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657152000000",
"number": "1598498362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "474 STRATFORD RD",
"city": "LEXINGTON",
"state": "NC",
"postal_code": "272929653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 OLD LEXINGTON RD",
"city": "THOMASVILLE",
"state": "NC",
"postal_code": "273603428",
"telephone_number": "704-576-9298"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JACOB",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-07",
"last_updated": "2022-07-07",
"certification_date": "2022-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "2336",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCBATE LICENSE",
"identifier": "2336",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Thomasville, NC
- Heather Leighann Vandall
- Liju Varghese, MD
- Rheannon Lee Varker
- Emily Vernon, LCSWA
- Vicki C. Steed, LCSW
- Asif Wahid, MD
- Wake Forest Health Network LLC (Atrium Health Wake Forest Baptist Family Medicine - Thomasville)
- Wake Forest University Health Sciences
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3503)
- Wal-Mart Stores East, LP (Vision Center 30-3503)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.