Organization
LAGRANGE COLLEGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROB DICKS (CONTACT NAME)
(706) 880-8099
Entity
Organization
Contact information
Practice address
601 BROAD ST, LAGRANGE, GA 30240-2955
(706) 880-8099
Mailing address
PO BOX 819020, DALLAS, TX 75381-9020
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/14/2011
Last updated
09/14/2011
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