Provider Demographics
NPI:1912180217
Name:APPALACHIAN SURGICAL PRACTICE, P.C.
Entity Type:Organization
Organization Name:APPALACHIAN SURGICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:EFIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-781-6950
Mailing Address - Street 1:PO BOX 2627
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514
Mailing Address - Country:US
Mailing Address - Phone:706-781-6950
Mailing Address - Fax:706-781-6955
Practice Address - Street 1:37 HOSPITAL WAY BUILDING 9, SUITE B
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3144
Practice Address - Country:US
Practice Address - Phone:706-781-6950
Practice Address - Fax:706-781-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035408208600000X
GA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000503269AMedicaid
GAE14636Medicare UPIN
GAGRP6515Medicare PIN