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General NPI Number Information
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NPI Number | 1124416367
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Entity Type | Organization
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Legal Business Name | MILTON HALL SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 3330 PRESTON RIDGE RD SUITE 240
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City | ALPHARETTA
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State | GA
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Zip | 30005-4508
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Country | US
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Telephone | 770-740-1860
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Fax |
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Provider Business Mailing Address
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Address Line | 2980 N BEVERLY GLEN CIR SUITE # 301
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City | LOS ANGELES
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State | CA
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Zip | 90077-1726
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Country | US
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Telephone | 310-943-4180
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Fax | 888-431-8819
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JEFFREY GALLUPS
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Credential | MD
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Telephone | 770-740-1860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 58959
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License Number State | GA
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