Healthcare Provider Details

I. General information

NPI: 1639300478
Provider Name (Legal Business Name): HABERSHAM SURGICAL ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1678 FALLS ROAD
TOCCOA GA
30577-2411
US

IV. Provider business mailing address

PO BOX 953
TOCCOA GA
30577-1416
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-0628
  • Fax: 706-886-3735
Mailing address:
  • Phone: 706-886-0628
  • Fax: 706-886-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ROBERT T BUCHANAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 706-886-0628