Provider Demographics
NPI:1104958487
Name:ASSOCIATES IN GENERAL SURGERY, LLC
Entity type:Organization
Organization Name:ASSOCIATES IN GENERAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEITHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-362-4554
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-0867
Mailing Address - Country:US
Mailing Address - Phone:423-362-4554
Mailing Address - Fax:423-362-4550
Practice Address - Street 1:721 GLENWOOD DR.
Practice Address - Street 2:SUITE W-462
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-362-4554
Practice Address - Fax:423-362-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43386261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7585Medicare ID - Type UnspecifiedMEDICARE GROUP ID #