Healthcare Provider Details

I. General information

NPI: 1285157560
Provider Name (Legal Business Name): ZACHARY WILLIAMS LAT, ATC, OTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/21/2022
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MASON FARM RD
CHAPEL HILL NC
27514-4617
US

IV. Provider business mailing address

102 MASON FARM RD
CHAPEL HILL NC
27514-4617
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000033217
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-4742
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: