Healthcare Provider Details

I. General information

NPI: 1134168883
Provider Name (Legal Business Name): MERIDIAN SURGICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 SIXES RD SUITE 225
HOLLY SPRINGS GA
30115-8721
US

IV. Provider business mailing address

684 SIXES RD SUITE 225
HOLLY SPRINGS GA
30115-8721
US

V. Phone/Fax

Practice location:
  • Phone: 770-704-6101
  • Fax: 770-704-6316
Mailing address:
  • Phone: 770-704-6101
  • Fax: 770-704-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number053856
License Number StateGA

VIII. Authorized Official

Name: DR. ANUJ KUMAR DUA
Title or Position: PHYSICIAN
Credential: MD
Phone: 770-704-6101