Provider Demographics
NPI:1508054149
Name:MIDDLE GEORGIA SURGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MIDDLE GEORGIA SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BEDINGFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:478-275-4300
Mailing Address - Street 1:103 FAIRVIEW PARK DRIVE
Mailing Address - Street 2:J. ANDREW BEDINGFIELD, JR.
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2501
Mailing Address - Country:US
Mailing Address - Phone:478-275-4300
Mailing Address - Fax:478-275-4265
Practice Address - Street 1:103 FAIRVIEW PARK DRIVE
Practice Address - Street 2:J. ANDREW BEDINGFIELD, JR.
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2501
Practice Address - Country:US
Practice Address - Phone:478-275-4300
Practice Address - Fax:478-275-4265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027343208600000X
GA027343G302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00299582AMedicaid
GAD28897Medicare UPIN
GA00299582AMedicaid
GA02BDFXDMedicare PIN