Provider Demographics
NPI:1508883539
Name:COLUMBUS SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:COLUMBUS SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-328-1862
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39703-1019
Mailing Address - Country:US
Mailing Address - Phone:662-328-1862
Mailing Address - Fax:662-328-7597
Practice Address - Street 1:255 BAPTIST BLVD
Practice Address - Street 2:STE 307
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2011
Practice Address - Country:US
Practice Address - Phone:662-328-1862
Practice Address - Fax:662-328-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty