Individual
MR. SCOTT WILLIAM GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
438 KILLIAN AVE, ATTN: OHWS GROUP, SHAW AFB, SC 29152
(803) 895-3719
Mailing address
119 SAUSAGE LN, WEST COLUMBIA, SC 29170-2462
(803) 586-4944
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT1119
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT1119
DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
SC
Enumeration date
02/06/2006
Last updated
05/01/2023
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