Provider Demographics
NPI:1720228216
Name:SURGEONCARE PHYSICIANS OF GEORGIA, LLC
Entity Type:Organization
Organization Name:SURGEONCARE PHYSICIANS OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-553-3322
Mailing Address - Street 1:PO BOX 5048
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-5048
Mailing Address - Country:US
Mailing Address - Phone:706-336-8485
Mailing Address - Fax:336-553-3325
Practice Address - Street 1:611 HOSPITAL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1143
Practice Address - Country:US
Practice Address - Phone:706-336-8485
Practice Address - Fax:336-553-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G701227Medicare PIN