Provider Demographics
NPI:1609987262
Name:SOUTHWEST GEORGIA SURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:SOUTHWEST GEORGIA SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEALI
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-285-1530
Mailing Address - Street 1:100 WHEATLEY DR
Mailing Address - Street 2:PO BOX 663, SUITE 305
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3788
Mailing Address - Country:US
Mailing Address - Phone:229-928-1100
Mailing Address - Fax:229-928-1255
Practice Address - Street 1:100 WHEATLEY DR
Practice Address - Street 2:SUITE 305
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3788
Practice Address - Country:US
Practice Address - Phone:229-928-1100
Practice Address - Fax:229-928-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty