Provider Demographics
NPI:1942435516
Name:MEADOWS SURGICAL ARTS
Entity Type:Organization
Organization Name:MEADOWS SURGICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBYLKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-282-5238
Mailing Address - Street 1:30931 HIGHWAY 441 S
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-6655
Mailing Address - Country:US
Mailing Address - Phone:706-282-5238
Mailing Address - Fax:706-886-5242
Practice Address - Street 1:203 REMSDALE RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577
Practice Address - Country:US
Practice Address - Phone:706-282-5238
Practice Address - Fax:706-886-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty