Healthcare Provider Details

I. General information

NPI: 1649223173
Provider Name (Legal Business Name): GAINESVILLE SURGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 JESSE JEWELL PKWY SE SUITE 200
GAINESVILLE GA
30501-3871
US

IV. Provider business mailing address

1250 JESSE JEWELL PKWY SE SUITE 200
GAINESVILLE GA
30501-3871
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-6341
  • Fax: 770-532-0178
Mailing address:
  • Phone: 770-532-6341
  • Fax: 770-532-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHELBY DODD LOGGINS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-532-6341