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General NPI Number Information
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NPI Number | 1447659271
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Entity Type | Individual
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Provider Name | ERNEST GREGORY EUGENE MS, LAT, ATC, CES
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Gender | Male
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 605 WASHINGTON ST SW
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City | BLACKSBURG
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State | VA
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Zip | 24061-1064
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Country | US
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Telephone | 540-231-4071
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Fax | 540-231-7335
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Provider Business Mailing Address
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Address Line | 435 MAJESTIC DR
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-5077
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Country | US
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Telephone | 301-537-8188
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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 | 1033-39
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126002142
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.001873
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License Number State | OH
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