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General NPI Number Information
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NPI Number | 1033315924
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Entity Type | Organization
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Legal Business Name | CARROLLTON SURGICAL GROUP, P. A.
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 209 MAIN ST S
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City | WEDOWEE
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State | AL
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Zip | 36278-5139
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Country | US
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Telephone | 770-834-3336
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Fax | 770-832-2331
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Provider Business Mailing Address
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Address Line | 157 CLINIC AVE SUITE 302
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City | CARROLLTON
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State | GA
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Zip | 30117-4454
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Country | US
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Telephone | 770-834-3336
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Fax | 770-832-2331
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | JAN M ZEIS
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Credential |
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Telephone | 770-834-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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