Provider Demographics
NPI:1588755920
Name:SOUTH GEORGIA SURGERY CENTER
Entity type:Organization
Organization Name:SOUTH GEORGIA SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUPI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:912-267-9000
Mailing Address - Street 1:306 ISABELLA ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3636
Mailing Address - Country:US
Mailing Address - Phone:912-267-9000
Mailing Address - Fax:
Practice Address - Street 1:306 ISABELLA ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3636
Practice Address - Country:US
Practice Address - Phone:912-267-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
GA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical