# GEORGIA SOUTHERN UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Georgia Southern University Athletics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558615096
- **Authorized official:** PAUL FERGUSON (DIRECTOR)
- **Authorized official phone:** (912) 536-2239

## Contact information

- **Practice address:** 590 HERTY DRIVE, ROOM 1216, STATESBORO, GA 30458
- **Practice address phone:** (912) 478-7581
- **Practice address fax:** (912) 478-7690
- **Mailing address:** 590 HERTY DRIVE, ROOM 1216, STATESBORO, GA 30458
- **Mailing address phone:** (912) 478-7581
- **Mailing address fax:** (912) 478-7690

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QS1000X | Student Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/06/2012
- **Last updated:** 11/06/2012