Provider Demographics
NPI:1760353072
Name:GEORGIA SOUTHERN UNIVERSITY
Entity type:Organization
Organization Name:GEORGIA SOUTHERN UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-250-5470
Mailing Address - Street 1:PO BOX 8082
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30460-1000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HANNER FIELD HOUSE
Practice Address - Street 2:590 HERTY DRIVE ROOM 1216C
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30460-1000
Practice Address - Country:US
Practice Address - Phone:912-531-1436
Practice Address - Fax:912-478-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty