Healthcare Provider Details

I. General information

NPI: 1376640557
Provider Name (Legal Business Name): BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CARLTON ST. 593 ADERHOLD HALL
ATHENS GA
30602-5004
US

IV. Provider business mailing address

110 CARLTON ST
ATHENS GA
30602-5004
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-4598
  • Fax: 706-542-4574
Mailing address:
  • Phone: 706-542-4598
  • Fax: 706-542-4574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TERRY J RAGAN
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 919-937-4222