Provider Demographics
NPI:1811377815
Name:SOUTH ATLANTA UROLOGY & GYNECOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTH ATLANTA UROLOGY & GYNECOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-208-6324
Mailing Address - Street 1:5400 LAUREL SPRINGS PKWY
Mailing Address - Street 2:SUITE 1403
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6056
Mailing Address - Country:US
Mailing Address - Phone:678-904-5211
Mailing Address - Fax:678-904-5212
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY
Practice Address - Street 2:SUITE 1403
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6056
Practice Address - Country:US
Practice Address - Phone:678-904-5211
Practice Address - Fax:678-904-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054434208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty