Provider Demographics
NPI:1972005155
Name:AMED SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:AMED SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOUF
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:404-615-5551
Mailing Address - Street 1:2844 BARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-4834
Mailing Address - Country:US
Mailing Address - Phone:404-615-5551
Mailing Address - Fax:
Practice Address - Street 1:2844 BARRETT AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-4834
Practice Address - Country:US
Practice Address - Phone:404-449-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization