Provider Demographics
NPI:1609067768
Name:MADISON GENERAL SURGERY, PLLC
Entity Type:Organization
Organization Name:MADISON GENERAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-366-1011
Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:SUITE 1252
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-366-6606
Mailing Address - Fax:601-366-6647
Practice Address - Street 1:106 HIGHLAND WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6915
Practice Address - Country:US
Practice Address - Phone:601-366-6606
Practice Address - Fax:601-366-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical