Provider Demographics
NPI:1952451585
Name:ALBANY GENERAL SURGERY P.C.
Entity Type:Organization
Organization Name:ALBANY GENERAL SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:PARKS
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-436-1830
Mailing Address - Street 1:910 N JEFFERSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2385
Mailing Address - Country:US
Mailing Address - Phone:229-436-1830
Mailing Address - Fax:
Practice Address - Street 1:910 N JEFFERSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2385
Practice Address - Country:US
Practice Address - Phone:229-436-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52867208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH02161Medicare UPIN
GA02BBGKTMedicare ID - Type Unspecified