Provider Demographics
NPI:1063173920
Name:WALDROP, ERIC G (MOL, ATC, LAT, SCAT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:WALDROP
Suffix:
Gender:M
Credentials:MOL, ATC, LAT, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BUFFLEHEAD CIR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-3906
Mailing Address - Country:US
Mailing Address - Phone:864-270-1219
Mailing Address - Fax:
Practice Address - Street 1:6570 GA-145
Practice Address - Street 2:
Practice Address - City:CARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30521
Practice Address - Country:US
Practice Address - Phone:864-270-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0038072255A2300X
SCSC5098002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer