Healthcare Provider Details

I. General information

NPI: 1528268232
Provider Name (Legal Business Name): SPALDING SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 WILL STREET
GRIFFIN GA
30224-4236
US

IV. Provider business mailing address

655 WILL STREET
GRIFFIN GA
30224-4236
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-6072
  • Fax: 770-229-2111
Mailing address:
  • Phone: 770-229-6072
  • Fax: 770-229-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL V. ROBERTSON
Title or Position: PARTNER
Credential: M.D.
Phone: 770-229-6072