Provider Demographics
NPI:1972570943
Name:SURRATT, DARRELL SHAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:SHAWN
Last Name:SURRATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 WHEAT AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4360
Mailing Address - Country:US
Mailing Address - Phone:229-243-8462
Mailing Address - Fax:
Practice Address - Street 1:603 WHEAT AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4360
Practice Address - Country:US
Practice Address - Phone:229-243-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA840736398AMedicaid
GA055984OtherMEDICAL LICENSE
GA08BBRZNMedicare PIN
GAI31644Medicare UPIN