Healthcare Provider Details

I. General information

NPI: 1679545768
Provider Name (Legal Business Name): SURGICAL ASSOCIATES OF COLUMBUS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 18TH ST
COLUMBUS GA
31901-1524
US

IV. Provider business mailing address

920 18TH ST
COLUMBUS GA
31901-1524
US

V. Phone/Fax

Practice location:
  • Phone: 706-649-6600
  • Fax: 706-649-6614
Mailing address:
  • Phone: 706-649-6600
  • Fax: 706-649-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: KENNETH L GOLDMAN
Title or Position: PRESIDENT
Credential: MD FACS
Phone: 706-649-6600