Provider Demographics
NPI:1508088949
Name:CARTERSVILLE SURGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CARTERSVILLE SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:770-386-1261
Mailing Address - Street 1:PO BOX 200128
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-9003
Mailing Address - Country:US
Mailing Address - Phone:770-386-1261
Mailing Address - Fax:
Practice Address - Street 1:970 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:SUITE 240
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2159
Practice Address - Country:US
Practice Address - Phone:770-386-1261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6RP2642Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER