Healthcare Provider Details

I. General information

NPI: 1033315924
Provider Name (Legal Business Name): CARROLLTON SURGICAL GROUP, P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MAIN ST S
WEDOWEE AL
36278-5139
US

IV. Provider business mailing address

157 CLINIC AVE SUITE 302
CARROLLTON GA
30117-4454
US

V. Phone/Fax

Practice location:
  • Phone: 770-834-3336
  • Fax: 770-832-2331
Mailing address:
  • Phone: 770-834-3336
  • Fax: 770-832-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAN M ZEIS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-834-3336