Provider Demographics
NPI:1316178171
Name:MEADOWS SURGICAL ARTS
Entity Type:Organization
Organization Name:MEADOWS SURGICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:B.B.A.
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-335-3555
Mailing Address - Street 1:P.O. BOX 1238
Mailing Address - Street 2:30931 HWY 441 S
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529
Mailing Address - Country:US
Mailing Address - Phone:706-335-3555
Mailing Address - Fax:706-336-8122
Practice Address - Street 1:30931 HIGHWAY 441 S
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529
Practice Address - Country:US
Practice Address - Phone:706-282-5238
Practice Address - Fax:706-886-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045550207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1093708000Medicare PIN
GA000790534IMedicare PIN