Healthcare Provider Details

I. General information

NPI: 1891451704
Provider Name (Legal Business Name): CHRIS WILLIAMS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 11/15/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 COMMUNITY COLLEGE RD
CEDAR BLUFF VA
24609-9363
US

IV. Provider business mailing address

267 FOREST BROOK RD
LEBANON VA
24266-3531
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-7513
  • Fax:
Mailing address:
  • Phone: 828-775-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2218
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: