Healthcare Provider Details

I. General information

NPI: 1235245184
Provider Name (Legal Business Name): SOUTH GEORGIA SURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MIMOSA DR
THOMASVILLE GA
31792-6676
US

IV. Provider business mailing address

PO BOX 520
THOMASVILLE GA
31799-0520
US

V. Phone/Fax

Practice location:
  • Phone: 229-226-8881
  • Fax:
Mailing address:
  • Phone: 229-226-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN CASCONE
Title or Position: PHYSICIAN
Credential: MD
Phone: 229-226-8881