Healthcare Provider Details

I. General information

NPI: 1134670557
Provider Name (Legal Business Name): CATARACT AND LASER SURGERY CENTER OF SOUTH GEORGIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120-B N. VALDOSTA RD.
VALDOSTA GA
31602
US

IV. Provider business mailing address

4380 KINGS WAY
VALDOSTA GA
31602-6921
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-2068
  • Fax:
Mailing address:
  • Phone: 229-244-2068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALAN PEASLEE
Title or Position: ADMINISTRATOR
Credential:
Phone: 229-244-2068