Provider Demographics
NPI:1467508689
Name:GEORGIA MOUNTAIN SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:GEORGIA MOUNTAIN SURGICAL ASSOCIATES PC
Other - Org Name:APPALACHIAN SURGICAL PRACTICE PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:EFIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-781-6950
Mailing Address - Street 1:PO BOX 2238
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-2238
Mailing Address - Country:US
Mailing Address - Phone:706-781-6950
Mailing Address - Fax:706-781-6955
Practice Address - Street 1:207 HOSPITAL CIR
Practice Address - Street 2:SUITE A&B
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3128
Practice Address - Country:US
Practice Address - Phone:706-781-6950
Practice Address - Fax:706-781-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35408174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00503269AMedicaid
GA00503269AMedicaid
GAE14636Medicare UPIN