Provider Demographics
NPI:1154564268
Name:ADVANCED HAND AND UPPER EXTREMITY SURGERY, P.C.
Entity type:Organization
Organization Name:ADVANCED HAND AND UPPER EXTREMITY SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:LITTLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-367-8229
Mailing Address - Street 1:1505 NORTHSIDE BOULEVARD
Mailing Address - Street 2:SUITE 4500
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:937-367-8229
Mailing Address - Fax:770-664-7071
Practice Address - Street 1:1505 NORTHSIDE BOULEVARD
Practice Address - Street 2:SUITE 4500
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:937-367-8229
Practice Address - Fax:770-664-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048368207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH169900Medicaid
OH169900Medicaid