Organization
ALBANY STATE UNIVERSITY
Active
Other names
Albany State Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
504 COLLEGE DR, ALBANY, GA 31705-2717
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
008291
GA
Other
Enumeration date
09/12/2017
Last updated
09/12/2017
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