Healthcare Provider Details

I. General information

NPI: 1386684801
Provider Name (Legal Business Name): GENERAL SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 WHITESBURG DR SE SUITE 200
HUNTSVILLE AL
35802-1631
US

IV. Provider business mailing address

4704 WHITESBURG DR SE SUITE 200
HUNTSVILLE AL
35802-1631
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-4510
  • Fax: 256-880-4512
Mailing address:
  • Phone: 256-880-4510
  • Fax: 256-880-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER S WILSON
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 256-880-4510