Provider Demographics
NPI:1144327396
Name:NELSON, GARY G (ATC, SCAT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:G
Last Name:NELSON
Suffix:
Gender:M
Credentials:ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 RED BUD PARK
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2328
Mailing Address - Country:US
Mailing Address - Phone:803-469-4926
Mailing Address - Fax:
Practice Address - Street 1:2580 MCCRAYS MILL RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-6028
Practice Address - Country:US
Practice Address - Phone:803-481-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer