Provider Demographics
NPI:1831443936
Name:GEORGIA COLLEGE & STATE UNIVERSITY
Entity type:Organization
Organization Name:GEORGIA COLLEGE & STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM SR VP FOR FINANCE AND ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-445-5148
Mailing Address - Street 1:120 W CAMPUS DR
Mailing Address - Street 2:CBX 091
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-1990
Mailing Address - Country:US
Mailing Address - Phone:478-445-5288
Mailing Address - Fax:478-445-3142
Practice Address - Street 1:120 W CAMPUS DR
Practice Address - Street 2:CBX 091
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-1990
Practice Address - Country:US
Practice Address - Phone:478-445-5288
Practice Address - Fax:478-445-3142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health