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General NPI Number Information
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NPI Number | 1093139149
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Entity Type | Individual
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Provider Name | DAVID CRAIG OATES II ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 1051 BLOSSOM ST
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City | COLUMBIA
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State | SC
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Zip | 29208-0010
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Country | US
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Telephone | 803-777-0164
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 TRUE ST APT 218
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City | COLUMBIA
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State | SC
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Zip | 29209-1747
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Country | US
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Telephone | 919-770-5528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 520201
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License Number State | SC
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