1760353072 NPI number — GEORGIA SOUTHERN UNIVERSITY

Table of content: (NPI 1760353072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760353072 NPI number — GEORGIA SOUTHERN UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA SOUTHERN UNIVERSITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760353072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8082
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30460-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HANNER FIELD HOUSE
Provider Second Line Business Practice Location Address:
590 HERTY DRIVE ROOM 1216C
Provider Business Practice Location Address City Name:
STATESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30460-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-531-1436
Provider Business Practice Location Address Fax Number:
912-478-1017
Provider Enumeration Date:
09/17/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MASSAR
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
847-250-5470

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com