MEDICARE: CARROLLTON SURGICAL GROUP, P. A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417931825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARROLLTON SURGICAL GROUP, P. A.

Provider Business Mailing Address
First Line	:	157 CLINIC AVE
Second Line	:	SUITE 302
City	:	CARROLLTON
State	:	GA
Zip	:	30117-4413
Country	:	US
Telephone Number	:	770-834-3336
Fax Number	:	770-832-2136

Provider Business Practice Location Address
First Line	:	157 CLINIC AVE
Second Line	:	SUITE 302
City	:	CARROLLTON
State	:	GA
Zip	:	30117-4413
Country	:	US
Telephone Number	:	770-834-3336
Fax Number	:	770-832-2136

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	JAN M ZEIS
Credential	:
Telephone Number	:	770-834-3336

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	08/22/2020

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