Provider Demographics
NPI:1033305289
Name:CHESTATEE SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:CHESTATEE SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MCLEAN
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-864-7272
Mailing Address - Street 1:160 PROSPECTOR RDG
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-6181
Mailing Address - Country:US
Mailing Address - Phone:706-864-7272
Mailing Address - Fax:706-864-7080
Practice Address - Street 1:160 PROSPECTOR RDG
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-6181
Practice Address - Country:US
Practice Address - Phone:706-864-7272
Practice Address - Fax:706-864-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043118208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10050810OtherAMERIGROUP
GA52876062003OtherBCBS
GA856357016AMedicaid
GA325964OtherWELLCARE