Active NPI
Calvin Woodrow Keller, LAT-ATC
- Athletic Trainer
- Winston Salem, NC
National Provider Identifier
1912529934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- LAT-0810
- Practice address
- 3507 Midway School Rd
Winston Salem, NC 27107-8741 - Phone
- (336) 474-8280
- NPI assigned
- May 13, 2020
- Last updated
- May 13, 2020
- 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 | LAT-0810 | NC | Primary |
Addresses
Primary practice location
3507 Midway School Rd
Winston Salem, NC 27107-8741
Mailing address
18 Lodge Dr
Thomasville, NC 27360-2802
Phone (336) 906-2202
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 |
|---|---|---|---|
| LAT-0810 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589328000000",
"number": "1912529934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 LODGE DR",
"city": "THOMASVILLE",
"state": "NC",
"postal_code": "273602802",
"telephone_number": "336-906-2202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3507 MIDWAY SCHOOL RD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271078741",
"telephone_number": "336-474-8280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "CALVIN",
"middle_name": "WOODROW",
"name_prefix": "Mr.",
"credential": "LAT-ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-05-13",
"last_updated": "2020-05-13",
"certification_date": "2020-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "LAT-0810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.