Basic Information
| Provider Information | |||||||||
| NPI: | 1366004095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOGGINS | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | NATHAN | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 WINTHROP AVE | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296071636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645809397 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 PATEWOOD DR STE C100 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296156322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644547422 | ||||||||
| FaxNumber: | 8644547425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 09/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 246ZX2200X | Y |
No ID Information.