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Organization
GREENSBORO COLLEGE INC.,
Active
Organization
GREENSBORO COLLEGE INC.,
Active
Other names
GREENSBORO COLLEGE SPORTS MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (ADMINISTRATOR/AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
815 W MARKET ST, GREENSBORO, NC 27401-1823
(972) 367-4845
(972) 367-3451
Mailing address
15305 DALLAS PKWY STE 800, ADDISON, TX 75001-6415
(972) 367-4845
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
06/23/2022
Last updated
06/23/2022
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