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General NPI Number Information
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NPI Number | 1861568040
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALISTS OF GEORGIA, PC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/10/2009
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Provider Practice Location Address
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Address Line | 1250 JESSE JEWELL PKWY SE SUITE 300
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City | GAINESVILLE
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State | GA
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Zip | 30501-3871
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Country | US
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Telephone | 770-534-0110
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Fax | 770-534-2555
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Provider Business Mailing Address
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Address Line | 1250 JESSE JEWELL PKWY SE SUITE 300
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City | GAINESVILLE
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State | GA
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Zip | 30501-3871
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Country | US
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Telephone | 770-534-0110
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Fax | 770-534-2555
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MS. AMY D SEABOLT
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Credential | BSBA
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Telephone | 770-534-0110
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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 | 050992
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 059108
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN171688NP
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 035736
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License Number State | GA
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