Provider Demographics
NPI:1801226725
Name:CRANFORD, POWELL, AND MORRIS ADVANCED SURGICAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:CRANFORD, POWELL, AND MORRIS ADVANCED SURGICAL SPECIALISTS LLC
Other - Org Name:CPM ADVANCED SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER-ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-502-2195
Mailing Address - Street 1:775 POPLAR RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8300
Mailing Address - Country:US
Mailing Address - Phone:770-502-2150
Mailing Address - Fax:
Practice Address - Street 1:775 POPLAR RD
Practice Address - Street 2:SUITE 350
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8300
Practice Address - Country:US
Practice Address - Phone:770-502-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22738208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000256055DMedicaid
GA776369717EMedicaid
GA000020226JMedicaid
GA610657035CMedicaid