Healthcare Provider Details

I. General information

NPI: 1851580575
Provider Name (Legal Business Name): WEST AUGUSTA SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WRIGHTSBORO RD
AUGUSTA GA
30904-6233
US

IV. Provider business mailing address

2320 WRIGHTSBORO RD
AUGUSTA GA
30904-6233
US

V. Phone/Fax

Practice location:
  • Phone: 706-737-7922
  • Fax: 706-737-7968
Mailing address:
  • Phone: 706-737-7922
  • Fax: 706-737-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number13372
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number029298
License Number StateGA

VIII. Authorized Official

Name: HOWARD STALLINGS
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-737-7922