Provider Demographics
NPI:1346217908
Name:CSRA SURGICAL SOLUTIONS PC
Entity Type:Organization
Organization Name:CSRA SURGICAL SOLUTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS BILLING DEPT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-863-9595
Mailing Address - Street 1:3624 J DEWEY GRAY CIR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6667
Mailing Address - Country:US
Mailing Address - Phone:706-855-9565
Mailing Address - Fax:
Practice Address - Street 1:3624 J DEWEY GRAY CIR
Practice Address - Street 2:SUITE 250
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6667
Practice Address - Country:US
Practice Address - Phone:706-855-9565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000713402CMedicaid
GA000713402CMedicaid