Healthcare Provider Details

I. General information

NPI: 1134180508
Provider Name (Legal Business Name): JOHN DOUGLAS HANDLEY A.T.,C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 UNIVERSITY WAY
SPARTANBURG SC
29303-4932
US

IV. Provider business mailing address

418 BENTRIDGE DR
SPARTANBURG SC
29301-5962
US

V. Phone/Fax

Practice location:
  • Phone: 864-503-5104
  • Fax: 864-503-5130
Mailing address:
  • Phone: 864-237-7874
  • Fax: 864-503-5130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number675
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: