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General NPI Number Information
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NPI Number | 1043338502
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Entity Type | Organization
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Legal Business Name | HEART OF GEORGIA UROLOGY ASSOCIATES,LLC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 FAIRVIEW PARK DR
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City | DUBLIN
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State | GA
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Zip | 31021-2547
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Country | US
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Telephone | 478-272-6150
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Fax | 478-272-4903
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Provider Business Mailing Address
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Address Line | 200 FAIRVIEW PARK DR
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City | DUBLIN
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State | GA
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Zip | 31021-2547
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Country | US
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Telephone | 478-272-6150
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Fax | 478-272-4903
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CLAIRE S LEVERETT
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Credential |
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Telephone | 478-272-6150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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