Provider Demographics
NPI:1891768917
Name:SURGICAL ASSOCIATES OF VALDOSTA, P.C.
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF VALDOSTA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-242-4996
Mailing Address - Street 1:2704 N OAK ST
Mailing Address - Street 2:BLDG F
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1744
Mailing Address - Country:US
Mailing Address - Phone:229-242-4996
Mailing Address - Fax:229-242-2306
Practice Address - Street 1:2704 N OAK ST
Practice Address - Street 2:BLDG F
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1744
Practice Address - Country:US
Practice Address - Phone:229-242-4996
Practice Address - Fax:229-242-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherEIN
GAGRP507Medicare ID - Type UnspecifiedMEDICARE GROUP ID #