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Organization
GEORGETOWN COLLEGE, INC
Active
Organization
GEORGETOWN COLLEGE, INC
Active
Other names
Georgetown Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
STACEE GIBSON (ASSISTANT ATHLETIC TRAINER)
(859) 274-2128
Entity
Organization
Contact information
Practice address
400 E COLLEGE ST, GEORGETOWN, KY 40324-1628
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
(972) 367-4845
(972) 367-3451
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
10/10/2018
Last updated
10/10/2018
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