1881889871 NPI number — PIEDMONT REGIONAL SURGICAL

Table of content: (NPI 1881889871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881889871 NPI number — PIEDMONT REGIONAL SURGICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT REGIONAL SURGICAL
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:
6
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:
1881889871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1473
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLEDGEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31059-1473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-452-1024
Provider Business Mailing Address Fax Number:
478-452-0447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 N COBB ST STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLEDGEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31061-7168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-452-1024
Provider Business Practice Location Address Fax Number:
478-452-0447
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OVERMAN
Authorized Official First Name:
ALISHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
478-452-1024

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GRP6491 . This is a "MEDICARE GROUP#" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com