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General NPI Number Information
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NPI Number | 1164093068
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Entity Type | Organization
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Legal Business Name | CLEAVER MEDICAL GROUP SURGERY CENTER
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 105 PROFESSIONAL PARK DR STE 200
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City | CUMMING
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State | GA
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Zip | 30040-2381
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Country | US
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Telephone | 770-800-3455
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Fax | 770-284-8380
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Provider Business Mailing Address
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Address Line | 105 PROFESSIONAL PARK DR STE 200
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City | CUMMING
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State | GA
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Zip | 30040-2381
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Country | US
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Telephone | 770-872-6179
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Fax | 678-302-6127
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Authorized Official
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Title or Position | OWNER
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Name | MIRANDA L REED
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Credential | DO
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Telephone | 770-872-6179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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