Provider Demographics
NPI:1679942973
Name:SURGICAL PHYSICIANS OF ATLANTA
Entity Type:Organization
Organization Name:SURGICAL PHYSICIANS OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-306-1985
Mailing Address - Street 1:890 ATLANTA ST
Mailing Address - Street 2:STE 161
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4456
Mailing Address - Country:US
Mailing Address - Phone:470-306-1985
Mailing Address - Fax:
Practice Address - Street 1:890 ATLANTA ST
Practice Address - Street 2:STE 161
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4456
Practice Address - Country:US
Practice Address - Phone:470-306-1985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037519208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty