Provider Demographics
NPI:1821164021
Name:COLON AND RECTAL SURGERY ASSOCIATES, PC
Entity Type:Organization
Organization Name:COLON AND RECTAL SURGERY ASSOCIATES, PC
Other - Org Name:COLON AND RECTAL SURGERY ASSOCIATES, P.C,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-724-5451
Mailing Address - Street 1:1430 HARPER ST STE B
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-0619
Mailing Address - Country:US
Mailing Address - Phone:706-722-2118
Mailing Address - Fax:706-722-0342
Practice Address - Street 1:1430 HARPER ST STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-0619
Practice Address - Country:US
Practice Address - Phone:706-722-2118
Practice Address - Fax:706-722-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300028738AMedicaid
SCGPA529Medicaid