MEDICARE: GEORGIA LAPAROSPIC SURGICAL SPECIALISTS PC

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	049071	GA

General Provider Information

NPI Number	:	1699964858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA LAPAROSPIC SURGICAL SPECIALISTS PC

Provider Business Mailing Address
First Line	:	PO BOX 1310
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-1310
Country	:	US
Telephone Number	:	770-266-6252
Fax Number	:	770-266-6282

Provider Business Practice Location Address
First Line	:	704 BREEDLOVE DR STE B
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2054
Country	:	US
Telephone Number	:	770-266-6252
Fax Number	:

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DAVID NORMAN
Credential	:
Telephone Number	:	770-266-6252

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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