Gary Blaine Wilkerson, ED.D., A.T.C.

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0000000502 Issued in TN

Practice address

615 McCallie Ave
Department 6606
Chattanooga, TN 37403-2504

Phone

(423) 425-5394

Fax

(423) 425-5395

NPI assigned

Jun 27, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

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": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639106362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 BIG ROCK RD",
            "city": "SIGNAL MOUNTAIN",
            "state": "TN",
            "postal_code": "373772007",
            "telephone_number": "423-886-2998",
            "fax_number": "423-425-5395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 MCCALLIE AVE",
            "address_2": "DEPARTMENT 6606",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374032504",
            "telephone_number": "423-425-5394",
            "fax_number": "423-425-5395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "GARY",
        "middle_name": "BLAINE",
        "name_prefix": "Dr.",
        "credential": "ED.D., A.T.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TN",
            "license": "0000000502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cleo B Wilde, LCSW
• David Alan Wiles, MD
• Michael Todd Wiles, DPM
• Emily Grace Wiley
• Shuntal L Wiley
• Tyronda Wilkerson
• Justin Grant Wilkes, MD
• Randy Millard Wilkes Jr., ATC
• Haley Abbigail Haren Wilkins, MA, LCP-MSHP TEMPATR
• Margaret A. Wilkins, PHD

• Athletic Trainer in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Athletic Trainer in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.