Provider Demographics
NPI:1033111638
Name:GCSU ATHLETIC TRAINING
Entity Type:Organization
Organization Name:GCSU ATHLETIC TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:ATC/LAT
Authorized Official - Phone:478-445-1787
Mailing Address - Street 1:320 N WAYNE ST
Mailing Address - Street 2:CBX 65
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2857
Mailing Address - Country:US
Mailing Address - Phone:478-445-1787
Mailing Address - Fax:706-497-6406
Practice Address - Street 1:251 S CLARK ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-445-1787
Practice Address - Fax:478-445-1790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA COLLEGE & STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-12
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty