Organization
VALDOSTA STATE UNIVERSITY
Active
Other names
Valdosta State University Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JAY JOHNSON MS LAT (HEAD ATHLETIC TRAINER)
(229) 333-5897
Entity
Organization
Contact information
Practice address
1500 N PATTERSON ST, VALDOSTA, GA 31698-0100
(229) 333-5897
Mailing address
1500 N PATTERSON ST, VALDOSTA, GA 31698-0100
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
10/11/2011
Last updated
12/19/2022
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