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General NPI Number Information
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NPI Number | 1871440404
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Entity Type | Organization
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Legal Business Name | GEORGIA SOUTHERN UNIVERSITY
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Dates
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Enumeration Date | 03/12/2026
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | TED SMITH FAMILY FOOTBALL CENTER 205 LANIER DRIVE
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City | STATESBORO
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State | GA
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Zip | 30458-1524
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Country | US
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Telephone | 912-478-5509
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Fax |
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Provider Business Mailing Address
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Address Line | 205 LANIER DR
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City | STATESBORO
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State | GA
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Zip | 30458-1524
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Country | US
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Telephone | 912-478-5509
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MATTHEW MASAR
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Credential |
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Telephone | 847-250-5470
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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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