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General NPI Number Information
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NPI Number | 1073733028
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Entity Type | Individual
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Provider Name | SUZANNE M KONZ PH.D ATC CSCS
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5045 SCOTCH PINE AVE
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City | STATESBORO
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State | GA
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Zip | 30458-9217
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Country | US
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Telephone | 912-764-7037
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Fax |
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Provider Business Mailing Address
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Address Line | GOERGIA SOUTHERN UNIVERSITY PO BOX 8076
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City | STATESBORO
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State | GA
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Zip | 30460-0001
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Country | US
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Telephone | 912-486-7734
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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 |
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License Number State |
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