Dawg Mentality Sports Performance LLC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Legal business name

DAWG MENTALITY SPORTS PERFORMANCE LLC

Practice address

829 Golden Horseshoe LN
Sanford, NC 27330-7311

Phone

(919) 698-7479

NPI assigned

Aug 17, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Israel Williams, CSCS

Title

Executive Manager

Phone

(919) 698-7479

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1831865237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 GOLDEN HORSESHOE LN",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273307311",
            "telephone_number": "919-698-7479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 GOLDEN HORSESHOE LN",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273307311",
            "telephone_number": "919-698-7479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAWG MENTALITY SPORTS PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ISRAEL",
        "authorized_official_title_or_position": "EXECUTIVE MANAGER",
        "authorized_official_telephone_number": "919-698-7479",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CSCS"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCDMV",
            "identifier": "30649936",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.instagram.com/dmsportsperformancetraining/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "829 Golden Horseshoe Ln",
            "city": "Sanford",
            "state": "NC",
            "country_code": "US",
            "postal_code": "273307311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Athletic Trainer in Sanford, NC
• Providers in Sanford, NC by specialty
• Athletic Trainer in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; 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.