Active NPI
George Edward McGovern IV, ATC
- Athletic Trainer
- Destrehan, LA
National Provider Identifier
1831602473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- ATH.20088
- Practice address
- 1 Wildcat LN
Destrehan, LA 70047-4001 - Phone
- (601) 433-3333
- NPI assigned
- Nov 6, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | ATH.20088 | LA | Primary |
Addresses
Primary practice location
1 Wildcat LN
Destrehan, LA 70047-4001
Mailing address
106 Arline CT
Montz, LA 70068-8978
Phone (601) 433-3333
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ATH.20088 | LA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509926400000",
"number": "1831602473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 ARLINE CT",
"city": "MONTZ",
"state": "LA",
"postal_code": "700688978",
"telephone_number": "601-433-3333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WILDCAT LN",
"city": "DESTREHAN",
"state": "LA",
"postal_code": "700474001",
"telephone_number": "601-433-3333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGOVERN",
"first_name": "GEORGE",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"name_suffix": "IV",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-11-06",
"last_updated": "2017-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "LA",
"license": "ATH.20088",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Destrehan, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.