Provider Demographics
NPI:1073271177
Name:BATE, KEITH (ATC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:BATE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 OAKLAND RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3758
Mailing Address - Country:US
Mailing Address - Phone:404-480-9330
Mailing Address - Fax:
Practice Address - Street 1:965 OAKLAND RD STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3758
Practice Address - Country:US
Practice Address - Phone:404-480-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0018012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAT001801OtherATHLETIC TRAINING STATE LICENSURE
GA2000002679OtherNATIONAL ATHLETIC TRAINING ASSC BOARD OF CERTIFICATION
GA1298OtherNATIONAL BOARD OF CERTIFICATION OF ORTHOPEDIC PHYSICIANS ASSISTANTS