Provider Demographics
NPI:1336470848
Name:SURGICAL CLINIC OF GRIFFIN-SPALDING, P.C.
Entity Type:Organization
Organization Name:SURGICAL CLINIC OF GRIFFIN-SPALDING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LAZENBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-233-1080
Mailing Address - Street 1:220 W COLLEGE ST STE B
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4250
Mailing Address - Country:US
Mailing Address - Phone:770-233-1080
Mailing Address - Fax:770-233-3680
Practice Address - Street 1:220 W COLLEGE ST STE B
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4250
Practice Address - Country:US
Practice Address - Phone:770-233-1080
Practice Address - Fax:770-233-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G705872OtherMEDICARE PTAN