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General NPI Number Information
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NPI Number | 1184872723
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOICATES OF METRO ATLANTA, LLC
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 1612 MILSTEAD RD NE
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City | CONYERS
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State | GA
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Zip | 30012-3738
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Country | US
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Telephone | 770-602-1292
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 MILSTEAD RD NE
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City | CONYERS
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State | GA
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Zip | 30012-3738
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Country | US
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Telephone | 770-602-1292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONALD ANGUS MAYNARD
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Credential | MD
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Telephone | 770-602-1292
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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 | GA052463
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License Number State | GA
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