Healthcare Provider Details

I. General information

NPI: 1811543184
Provider Name (Legal Business Name): MIDDLE GEORGIA SURGICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 OSIGIAN BLVD STE 1
WARNER ROBINS GA
31088-8013
US

IV. Provider business mailing address

504 OSIGIAN BLVD STE 1
WARNER ROBINS GA
31088-8013
US

V. Phone/Fax

Practice location:
  • Phone: 478-219-7396
  • Fax: 949-404-8490
Mailing address:
  • Phone: 478-219-7396
  • Fax: 949-404-8490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK NARTEY NARH-MARTEY
Title or Position: OWNER
Credential: MD
Phone: 478-219-7396