Provider Demographics
NPI:1164761185
Name:STONES RIVER SURGICAL GROUP PLLC
Entity Type:Organization
Organization Name:STONES RIVER SURGICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:DURGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-895-3890
Mailing Address - Street 1:1009 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2450
Mailing Address - Country:US
Mailing Address - Phone:615-895-3890
Mailing Address - Fax:
Practice Address - Street 1:1009 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2450
Practice Address - Country:US
Practice Address - Phone:615-895-3890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49113208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty