Active NPI
Wade D Ollis, ATC, LAT, CSCS
- Athletic Trainer
- Gadsden, AL
National Provider Identifier
1730423302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 143
- Practice address
- 426 S 4TH St
Gadsden, AL 35901-5259 - Phone
- (256) 543-2981
- NPI assigned
- Nov 20, 2012
- 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 | 143 | AL | Primary |
Addresses
Primary practice location
426 S 4TH St
Gadsden, AL 35901-5259
Mailing address
60 Village Trace Dr
Springville, AL 35146-9001
Phone (205) 467-3339
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 |
|---|---|---|---|
| 143 | AL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353369600000",
"number": "1730423302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 VILLAGE TRACE DR",
"city": "SPRINGVILLE",
"state": "AL",
"postal_code": "351469001",
"telephone_number": "205-467-3339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "426 S 4TH ST",
"city": "GADSDEN",
"state": "AL",
"postal_code": "359015259",
"telephone_number": "256-543-2981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLLIS",
"first_name": "WADE",
"middle_name": "D",
"credential": "ATC, LAT, CSCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-20",
"last_updated": "2012-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AL",
"license": "143",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gadsden, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.