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Organization

MIDDLE GEORGIA STATE UNIVERSITY

Active
Other names
Middle Georgia State University Sports Medicine
Organization subpart
No

Provider details

NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization

Contact information

Practice address
1100 2ND ST SE, COCHRAN, GA 31014-1564
(972) 367-4845
(972) 367-3451
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
(800) 555-9073
(972) 367-3452

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207QS0010X
Sports Medicine (Family Medicine) Physician

Other

Enumeration date
10/19/2015
Last updated
10/19/2015
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