Provider Demographics
NPI:1235245184
Name:SOUTH GEORGIA SURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:SOUTH GEORGIA SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASCONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-226-8881
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-0520
Mailing Address - Country:US
Mailing Address - Phone:229-226-8881
Mailing Address - Fax:
Practice Address - Street 1:100 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6676
Practice Address - Country:US
Practice Address - Phone:229-226-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACE1020OtherRAILROAD MEDICARE
GAGRP2069Medicare PIN