Provider Demographics
NPI:1700054327
Name:SOUTH GEORGIA ANESTHESIA SPECIALISTS LLC
Entity Type:Organization
Organization Name:SOUTH GEORGIA ANESTHESIA SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:POTYONDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-671-2000
Mailing Address - Street 1:PO BOX 8846
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27419-0846
Mailing Address - Country:US
Mailing Address - Phone:336-553-1659
Mailing Address - Fax:336-553-3994
Practice Address - Street 1:4280 N VALDOSTA RD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6814
Practice Address - Country:US
Practice Address - Phone:229-671-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-16
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA042441559AMedicaid
GA511G700269Medicare PIN