Fort Valley State University
Organization Active NPI Internal Medicine Physician · Fort Valley, GA
NPI 1457737769 · NPPES record last updated Aug 10, 2015
Key facts
- NPI
- 1457737769
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- FORT VALLEY STATE UNIVERSITY
- Practice address
- 1005 State University Dr
Fort Valley, GA 31030-4313 - Phone
- (478) 825-6195
- NPI assigned
- Aug 10, 2015
- Organization subpart
- No
Authorized official
- Name
- Mouzon Bass III
- Title
- Agent
- Phone
- (972) 367-4845
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Sports Medicine (Internal Medicine) Physician |
207RS0010X |
Addresses
Primary practice location
1005 State University Dr
Fort Valley, GA 31030-4313
Mailing address
PO Box 650850
Dallas, TX 75265-0850
Phone (800) 555-9073
Other names
- FVSUSports Medicine
Other providers in Fort Valley, GA
- Fort Valley Dialysis Center LLC
- Fort Valley Drug Company LLC.
- Fort Valley Drug Company LLC. LTC
- Fort Valley Family Chiropractic, LLC
- Fort Valley Operator LLC
- Fruit of the Spirit Companion Services
- Fruit of the Spirit Companion Services
- Ft Valley Chiropractic Clinic PC
- Dennis Wayne Garrett Jr.
- Gayton Health Centre
All providers in Fort Valley, GA · Internal Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.