Provider Demographics
NPI:1790962215
Name:SPEIGHTS SURGICAL SUITES
Entity Type:Organization
Organization Name:SPEIGHTS SURGICAL SUITES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEIGHTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD/CSA
Authorized Official - Phone:404-646-5234
Mailing Address - Street 1:805 SOUTH GLYNN STREET
Mailing Address - Street 2:SUITE 127-135
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:404-646-5234
Mailing Address - Fax:
Practice Address - Street 1:150 RAVENCLIFF LN
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-4928
Practice Address - Country:US
Practice Address - Phone:770-909-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty