Provider Demographics
NPI:1124223227
Name:GOLDEN ISLES CENTER FOR GENERAL AND BARIATRIC SURGERY
Entity Type:Organization
Organization Name:GOLDEN ISLES CENTER FOR GENERAL AND BARIATRIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-264-9724
Mailing Address - Street 1:3226 HAMPTON AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4225
Mailing Address - Country:US
Mailing Address - Phone:912-264-9724
Mailing Address - Fax:
Practice Address - Street 1:3226 HAMPTON AVE
Practice Address - Street 2:SUITE F
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4225
Practice Address - Country:US
Practice Address - Phone:912-264-9724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty