Provider Demographics
NPI:1174506844
Name:NORTHEAST GEORGIA SURGICAL CONSULTANTS PC
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA SURGICAL CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-543-9023
Mailing Address - Street 1:1270 PRINCE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2762
Mailing Address - Country:US
Mailing Address - Phone:706-543-9023
Mailing Address - Fax:706-543-8160
Practice Address - Street 1:1270 PRINCE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2762
Practice Address - Country:US
Practice Address - Phone:706-543-9023
Practice Address - Fax:706-543-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-27
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN
GRP3274Medicare ID - Type UnspecifiedMEDICARE GROUP