Provider Demographics
NPI:1629106075
Name:ATHENS AREA SURGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ATHENS AREA SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-613-1040
Mailing Address - Street 1:700 SUNSET DR
Mailing Address - Street 2:SUITE 503
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2293
Mailing Address - Country:US
Mailing Address - Phone:706-613-1040
Mailing Address - Fax:706-613-9120
Practice Address - Street 1:700 SUNSET DR
Practice Address - Street 2:SUITE 503
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2288
Practice Address - Country:US
Practice Address - Phone:706-613-1040
Practice Address - Fax:706-613-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE46053Medicare UPIN