NPIMap

Organization Active NPI

Valdosta State University

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Valdosta, GA
National Provider Identifier
1962787804
Registry record updated Dec 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
VALDOSTA STATE UNIVERSITY
Practice address
1500 N Patterson St
Valdosta, GA 31698-0100
Phone
(229) 333-5897
NPI assigned
Oct 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jay Johnson, MS LATNPI 1942350954
Title
Head Athletic Trainer
Phone
(229) 333-5897

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X Primary
Athletic TrainerGroup: 193200000X MULTI-SPECIALTY GROUP 2255A2300X

Addresses

Primary practice location

1500 N Patterson St
Valdosta, GA 31698-0100

Mailing address

1500 N Patterson St
Valdosta, GA 31698-0100

Other names 1

  • Valdosta State University Sports Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Valdosta State University4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1500 N Patterson St
Valdosta, GA 31698
Phone (229) 333-5800

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1962787804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N PATTERSON ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316980100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N PATTERSON ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316980100",
            "telephone_number": "229-333-5897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALDOSTA STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-11",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "HEAD ATHLETIC TRAINER",
        "authorized_official_telephone_number": "229-333-5897",
        "authorized_official_credential": "MS LAT"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valdosta State University Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.