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General NPI Number Information
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NPI Number | 1629000195
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Entity Type | Organization
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Legal Business Name | GENERAL AND THORACIC SURGERY OF GEORGIA,LLC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 2400 BELLEVUE RD ERIN OFFICE PARK # 11
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City | DUBLIN
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State | GA
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Zip | 31021-2885
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Country | US
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Telephone | 478-274-1114
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Fax | 478-274-1016
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Provider Business Mailing Address
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Address Line | 2400 BELLEVUE RD ERIN OFFICE PARK # 11
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City | DUBLIN
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State | GA
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Zip | 31021-2885
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Country | US
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Telephone | 478-274-1114
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Fax | 478-274-1016
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Authorized Official
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Title or Position | VP
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Name | MARK PICKETT
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Credential |
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Telephone | 678-762-5037
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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 |
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License Number State |
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