Healthcare Provider Details

I. General information

NPI: 1376370098
Provider Name (Legal Business Name): JOHN HOLBROOK ENGLISH III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SALUDA POINTE DR
LEXINGTON SC
29072-7295
US

IV. Provider business mailing address

109 ANADALE LN
LEXINGTON SC
29072-7116
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-9290
  • Fax:
Mailing address:
  • Phone: 803-553-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR.2254ATH
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: