Provider Demographics
NPI:1023422417
Name:GEORGIA SOUTHWESTERN STATE UNIVERSITY
Entity type:Organization
Organization Name:GEORGIA SOUTHWESTERN STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEAD TRAINER FOR SPORTS MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHN
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:229-931-2297
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:972-367-4835
Mailing Address - Fax:972-367-3451
Practice Address - Street 1:800 GSW UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709
Practice Address - Country:US
Practice Address - Phone:229-931-2225
Practice Address - Fax:229-931-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health