Provider Demographics
NPI:1871648808
Name:GENERAL SURGERY SERVICES, PC
Entity Type:Organization
Organization Name:GENERAL SURGERY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHOTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-840-5703
Mailing Address - Street 1:527 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1314
Mailing Address - Country:US
Mailing Address - Phone:678-540-5703
Mailing Address - Fax:678-540-5707
Practice Address - Street 1:527 NORTH AVE
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1314
Practice Address - Country:US
Practice Address - Phone:678-540-5703
Practice Address - Fax:678-540-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7745208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty