Provider Demographics
NPI:1124416367
Name:MILTON HALL SURGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:MILTON HALL SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLUPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-740-1860
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE # 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-943-4180
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:3330 PRESTON RIDGE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4508
Practice Address - Country:US
Practice Address - Phone:770-740-1860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILTON HALL SURGICAL ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-22
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58959332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site