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General NPI Number Information
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NPI Number | 1790076974
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Entity Type | Organization
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Legal Business Name | UPSON SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 612 WEST GORDON STREET SUITE E
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City | THOMASTON
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State | GA
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Zip | 30286-0027
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Country | US
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Telephone | 706-647-3116
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Fax | 706-648-3368
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Provider Business Mailing Address
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Address Line | PO BOX 1059 801 WEST GORDON STREET
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City | THOMASTON
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State | GA
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Zip | 30286-0027
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Country | US
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Telephone | 706-647-8111
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Fax | 706-646-3310
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Authorized Official
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Title or Position | CEO
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Name | MR. JEFFREY TARRANT
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Credential |
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Telephone | 706-647-8111
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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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