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General NPI Number Information
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NPI Number | 1437170347
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Entity Type | Organization
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Legal Business Name | GLENEAGLES SURGERY, PC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 1215 EAGLES LANDING PKWY #105
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7279
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Country | US
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Telephone | 770-506-2080
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Fax | 770-506-2767
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Provider Business Mailing Address
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Address Line | 1215 EAGLES LANDING PKWY #105
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7279
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Country | US
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Telephone | 770-506-2080
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Fax | 770-506-2767
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Authorized Official
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Title or Position | BILLER
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Name | MS. PIA BERKS
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Credential |
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Telephone | 770-506-2080
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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 | 026177
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License Number State | GA
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