Provider Demographics
NPI:1043577364
Name:SOUTHWEST SURGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:SOUTHWEST SURGICAL ASSOCIATES, P.C.
Other - Org Name:SOUTHWEST SURGICAL ASSOCIATES, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-427-9169
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-0467
Mailing Address - Country:US
Mailing Address - Phone:912-427-9169
Mailing Address - Fax:912-427-9171
Practice Address - Street 1:311 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0245
Practice Address - Country:US
Practice Address - Phone:912-427-9169
Practice Address - Fax:912-427-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055788208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty