Provider Demographics
NPI:1538311006
Name:BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA
Entity Type:Organization
Organization Name:BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA
Other - Org Name:THE UNIVERSITY OF GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UHC BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KUYKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-542-8638
Mailing Address - Street 1:55 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-1503
Mailing Address - Country:US
Mailing Address - Phone:706-542-8638
Mailing Address - Fax:706-583-0217
Practice Address - Street 1:55 CARLTON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1503
Practice Address - Country:US
Practice Address - Phone:706-542-8638
Practice Address - Fax:706-583-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103T00000X, 231H00000X, 291U00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory