Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Fort Valley State University

Organization Internal Medicine Physician · NPI 1457737769

Fort Valley State University is an Internal Medicine Physician in Fort Valley, Georgia. Registered with an NPI since 2015.

In the registry since
2015
Specialties on file
2

Practice location Address checks out

1005 State University Dr
Fort Valley, GA 31030-4313
Phone: (478) 825-6195
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Sports Medicine (Internal Medicine) Physician Taxonomy 207RS0010X

Record details

NPI number1457737769
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mouzon Bass — Agent · (972) 367-4845
Other names Fvsusports Medicine
NPI enumeratedAugust 10, 2015
Last updated in NPPESAugust 10, 2015
Mailing addressPo Box 650850, Dallas, TX 75265-0850

Other providers in Fort Valley