Provider Demographics
NPI:1518374032
Name:UNIVERSITY OF NORTH GEORGIA
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH GEORGIA
Other - Org Name:UNG SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MED, ATC
Authorized Official - Phone:706-864-1669
Mailing Address - Street 1:5050 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3995
Mailing Address - Country:US
Mailing Address - Phone:800-555-9073
Mailing Address - Fax:972-367-3452
Practice Address - Street 1:82 COLLEGE CIRCLE
Practice Address - Street 2:MEMORIAL HALL
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30597
Practice Address - Country:US
Practice Address - Phone:706-867-3212
Practice Address - Fax:706-867-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty