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General NPI Number Information
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NPI Number | 1679942973
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Entity Type | Organization
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Legal Business Name | SURGICAL PHYSICIANS OF ATLANTA
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 890 ATLANTA ST STE 161
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City | ROSWELL
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State | GA
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Zip | 30075-4456
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Country | US
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Telephone | 470-306-1985
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Fax |
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Provider Business Mailing Address
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Address Line | 890 ATLANTA ST STE 161
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City | ROSWELL
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State | GA
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Zip | 30075-4456
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Country | US
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Telephone | 470-306-1985
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOHN DALY
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Credential | M.D.
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Telephone | 407-306-1985
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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 | 037519
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License Number State | GA
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