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General NPI Number Information
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NPI Number | 1992801542
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1107 BROADRICK DR
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City | DALTON
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State | GA
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Zip | 30720-2592
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Country | US
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Telephone | 706-278-0351
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Fax | 706-226-5195
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Provider Business Mailing Address
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Address Line | 1107 BROADRICK DR
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City | DALTON
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State | GA
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Zip | 30720-2592
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Country | US
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Telephone | 706-278-0351
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Fax | 706-226-5195
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | MRS. LYDIA HENDERSON
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Credential |
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Telephone | 706-278-0351
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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 | GA
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