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
—
—
Other
Enumeration date
10/10/2018
Last updated
10/10/2018
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