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General NPI Number Information
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NPI Number | 1629406780
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF NORTHGEORGIA
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Dates
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Enumeration Date | 10/28/2013
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Last Update Date | 10/28/2013
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Provider Practice Location Address
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Address Line | 82 COLLEGE CIRCLE HNS BUILDING, SUITE102
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City | DAHLONEGA
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State | GA
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Zip | 30597-0001
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Country | US
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Telephone | 706-867-2713
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Fax | 706-867-3249
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Provider Business Mailing Address
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Address Line | 82 COLLEGE CIRCLE HNS BUILDING, SUITE102
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City | DAHLONEGA
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State | GA
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Zip | 30597-0001
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Country | US
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Telephone | 706-867-2713
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Fax | 706-867-3249
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Authorized Official
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Title or Position | PROJECT DIRECTOR
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Name | DR. KIM HUDSON-GALLOGLY
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Credential | PHD, APRN-BC
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Telephone | 706-864-1934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 113863
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 053488
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 169909
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License Number State | GA
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