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AUGUSTA UNIVERSITY
NPI 1215711155
Family Medicine - Sports Medicine in Augusta, GA

Active since August 22, 2023CLIA Certified · 3 labs
1120 15TH ST # B132, AUGUSTA, GA 30912(972) 367-4845(972) 367-3451 Get Directions Write a Review

NPPES record last updated: August 22, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Augusta University NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AUGUSTA UNIVERSITY (NPI 1215711155), doing business as Augusta University Athletics, is a healthcare organization registered as a sports medicine in Augusta, Georgia and active in the NPI registry since August 2023. The organization holds 3 active CLIA laboratory certificates and lists Mouzon Bass, Administrator/agent, as its authorized official.

NPPES Registry Identity

NPI1215711155
Entity TypeOrganization
Primary Taxonomy207QS0010X
Legal Business NameAUGUSTA UNIVERSITY
Location Address1120 15TH ST # B132Augusta, GA 30912-0004
Mailing Address15305 Dallas Pkwy Ste 800Addison, TX 75001-6415 · (972) 367-4845 · Fax (972) 367-3451
Phone(972) 367-4845
Fax(972) 367-3451
Organization SubpartNo
Authorized OfficialMouzon BassAdministrator/agent · (972) 367-4845
Enumeration DateAugust 22, 2023
NPPES CertifiedAugust 22, 2023
✔ NPI 1215711155 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QS0010X
Definition
A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
1120 15TH ST # B132, Augusta, GA 30912
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Other Names 1

Doing Business AsAugusta University Athletics

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2097518

Augusta University Clinical Trials Office · Augusta, GA
Active · expires Jun 16, 2027
CLIA Number11D2097518
Laboratory TypeClinical Trials Office
Certificate Effective DateJune 17, 2025
Certificate Expiration DateJune 16, 2027
Laboratory DirectorSoumia Brakta
Laboratory Phone(706) 721-9680
Laboratory LocationAugusta University Clinical Trials Office1521 Pope Avenue, Building Ff1001, Augusta, GA 30912
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 11D2321733

Augusta University Center Of Operational Medicine · Augusta, GA
Active · expires Apr 8, 2027
CLIA Number11D2321733
Laboratory TypeMed First Responder Vehic
Certificate Effective DateApril 9, 2025
Certificate Expiration DateApril 8, 2027
Laboratory DirectorRaymond M. Bussey
Laboratory Phone(706) 721-3548
Laboratory LocationAugusta University Center Of Operational Medicine1465 Laney Walker Boulevard, Af-2029, Augusta, GA 30912
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 11D0912447

Augusta University Hemoglobinopathy Laboratory · Augusta, GA
Active · expires Nov 22, 2026
CLIA Number11D0912447
Laboratory TypeOther
Certificate Effective DateNovember 23, 2024
Certificate Expiration DateNovember 22, 2026
Laboratory DirectorDr. Abdullah Kutlar
Laboratory Phone(706) 721-9640
Laboratory LocationAugusta University Hemoglobinopathy Laboratory989 St Sebastian Way Ef-201, Augusta, GA 30912
CLIA data matches this NPI record on: Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Augusta University's NPI number?

The NPI number for Augusta University is 1215711155. It was assigned to this organization in the NPPES registry on August 22, 2023. The provider is doing business as Augusta University Athletics.

Where is Augusta University located?

Augusta University is located at 1120 15th St # B132, Augusta, GA 30912. The listed phone number is (972) 367-4845.

What is Augusta University's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

Does Augusta University hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Augusta University was last updated on August 22, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.