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General NPI Number Information
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NPI Number | 1679626568
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Entity Type | Organization
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Legal Business Name | SANDERSVILLE SURGICAL
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 501 SPARTA RD STE C
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1314
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Country | US
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Telephone | 478-553-0232
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Fax | 478-553-1280
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Provider Business Mailing Address
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Address Line | 501 SPARTA RD STE C
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1314
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Country | US
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Telephone | 478-553-0232
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Fax | 478-553-1280
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Authorized Official
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Title or Position | MD
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Name | DR. DOUGLAS K RAWL
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Credential | MD
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Telephone | 478-553-0232
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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 | 054030
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License Number State | GA
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