Provider Demographics
NPI:1063856706
Name:KEYSTONE SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:KEYSTONE SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DLUGOS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:678-773-9399
Mailing Address - Street 1:2525 KIRK POINTE CV NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6239
Mailing Address - Country:US
Mailing Address - Phone:678-773-9399
Mailing Address - Fax:770-792-2263
Practice Address - Street 1:2525 KIRK POINTE CV NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-6239
Practice Address - Country:US
Practice Address - Phone:678-773-9399
Practice Address - Fax:770-792-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital