Organization
MERCER UNIVERSITY
Active
Other names
Mercer 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
1501 MERCER UNIVERSITY DR, MACON, GA 31207-1515
(478) 301-2994
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036295
GA
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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