Provider Demographics
NPI:1922563436
Name:UNIVERSITY OF NORTH GEORGIA RESEARCH FOUNDATION
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH GEORGIA RESEARCH FOUNDATION
Other - Org Name:UNG DPT FACULTY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TOCARRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-282-0081
Mailing Address - Street 1:159 SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30597-0001
Mailing Address - Country:US
Mailing Address - Phone:706-867-2747
Mailing Address - Fax:706-864-1493
Practice Address - Street 1:159 SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30597-0001
Practice Address - Country:US
Practice Address - Phone:706-867-2747
Practice Address - Fax:706-864-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy