Provider Demographics
NPI:1336337344
Name:SURGICAL ASSOCIATES OF SOUTH GEORGIA, P.C.
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF SOUTH GEORGIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-985-1080
Mailing Address - Street 1:3004 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6797
Mailing Address - Country:US
Mailing Address - Phone:229-985-1080
Mailing Address - Fax:229-890-9743
Practice Address - Street 1:3004 2ND ST SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6797
Practice Address - Country:US
Practice Address - Phone:229-985-1080
Practice Address - Fax:229-890-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2637OtherMEDICARE GROUP NUMBER