Healthcare Provider Details

I. General information

NPI: 1942435516
Provider Name (Legal Business Name): MEADOWS SURGICAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 REMSDALE RD
TOCCOA GA
30577
US

IV. Provider business mailing address

30931 HIGHWAY 441 S
COMMERCE GA
30529-6655
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-5238
  • Fax: 706-886-5242
Mailing address:
  • Phone: 706-282-5238
  • Fax: 706-886-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number045550
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JUSTIN KOBYLKA
Title or Position: OFFICE MGR
Credential:
Phone: 706-282-5238