Healthcare Provider Details

I. General information

NPI: 1023942844
Provider Name (Legal Business Name): GAVIN EDWARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OPPORTUNITY WAY
PICKERINGTON OH
43147-1296
US

IV. Provider business mailing address

725 BREVARD CIR
PICKERINGTON OH
43147-7855
US

V. Phone/Fax

Practice location:
  • Phone: 614-548-1800
  • Fax:
Mailing address:
  • Phone: 614-930-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT007366
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: