Provider Demographics
NPI:1033695572
Name:BORGET, NATHAN TYLER (MAED, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:TYLER
Last Name:BORGET
Suffix:
Gender:M
Credentials:MAED, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7840
Mailing Address - Country:US
Mailing Address - Phone:336-707-6548
Mailing Address - Fax:
Practice Address - Street 1:6632 DIXIE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31905-4218
Practice Address - Country:US
Practice Address - Phone:706-545-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0033402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAT003340OtherGEORGIA BOARD OF LICENSING