Provider Demographics
NPI:1992086862
Name:CRANFORD, POWELL AND MORRIS ADVANCED SURGICAL SPECIALISTS, L.L.C.
Entity type:Organization
Organization Name:CRANFORD, POWELL AND MORRIS ADVANCED SURGICAL SPECIALISTS, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-794-4715
Mailing Address - Street 1:775 POPLAR ROAD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8304
Mailing Address - Country:US
Mailing Address - Phone:770-502-2150
Mailing Address - Fax:770-502-2103
Practice Address - Street 1:775 POPLAR RD STE 260
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8303
Practice Address - Country:US
Practice Address - Phone:770-502-2150
Practice Address - Fax:770-502-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1134133002Medicaid