Provider Demographics
NPI:1326412420
Name:COLUMBUS SURGICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:COLUMBUS SURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-984-7400
Mailing Address - Street 1:1900 10TH AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3602
Mailing Address - Country:US
Mailing Address - Phone:706-984-7400
Mailing Address - Fax:706-984-7401
Practice Address - Street 1:1900 10TH AVE
Practice Address - Street 2:STE 201
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3602
Practice Address - Country:US
Practice Address - Phone:706-984-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063806208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G705233OtherPTAN