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General NPI Number Information
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NPI Number | 1205014057
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN SURGICAL ONCOLOGY
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Dates
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Enumeration Date | 02/04/2008
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 800 SPRING ST
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City | MACON
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State | GA
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Zip | 31201-2113
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Country | US
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Telephone | 478-745-3363
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Fax | 478-745-3330
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Provider Business Mailing Address
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Address Line | 800 SPRING ST
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City | MACON
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State | GA
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Zip | 31201-2113
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Country | US
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Telephone | 478-745-3363
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Fax | 478-745-3330
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Authorized Official
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Title or Position | SURGEON
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Name | DR. ARNOLD M CONFORTI
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Credential | M.D.
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Telephone | 478-745-3363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 051872
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License Number State | GA
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