Provider Demographics
NPI:1972822062
Name:SGI SURGICAL LLC
Entity Type:Organization
Organization Name:SGI SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSA
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-354-6940
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:PORTERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30070-0516
Mailing Address - Country:US
Mailing Address - Phone:770-354-6940
Mailing Address - Fax:404-671-9110
Practice Address - Street 1:65 MOTE CROSSING RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-5253
Practice Address - Country:US
Practice Address - Phone:770-354-6940
Practice Address - Fax:404-671-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3135363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty