1285782680 NPI number — THE GEORGIA SURGERY CLINIC, P.C.

Table of content: DR. BRIE WILLIAMS MD (NPI 1992718811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285782680 NPI number — THE GEORGIA SURGERY CLINIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GEORGIA SURGERY CLINIC, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285782680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
890 ATLANTA ST
Provider Second Line Business Mailing Address:
STE 161
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30075-4456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-306-1985
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 ATLANTA ST
Provider Second Line Business Practice Location Address:
STE 161
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30075-4456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-306-1985
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LARUE
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
C.E.O./OWNER
Authorized Official Telephone Number:
470-306-1985

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  037519 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)