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General NPI Number Information
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NPI Number | 1033695572
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Entity Type | Individual
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Provider Name | NATHAN TYLER BORGET MAED, LAT, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 6632 DIXIE RD
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City | COLUMBUS
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State | GA
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Zip | 31905-4218
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Country | US
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Telephone | 706-545-1788
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Fax |
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Provider Business Mailing Address
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Address Line | 3609 14TH AVE
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City | COLUMBUS
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State | GA
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Zip | 31904-7840
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Country | US
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Telephone | 336-707-6548
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT003340
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License Number State | GA
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