MEDICARE: CMG SURGICAL SPECIALISTS LLC

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

General Provider Information

NPI Number	:	1568147106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CMG SURGICAL SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	3830 ROSEMONT DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5659
Country	:	US
Telephone Number	:	706-221-6770
Fax Number	:	706-221-6776

Provider Business Practice Location Address
First Line	:	3830 ROSEMONT DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5659
Country	:	US
Telephone Number	:	706-221-6770
Fax Number	:	706-221-6776

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MALCOLM INGRAM GOODCHILD
Credential	:	MD
Telephone Number	:	917-561-5151

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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