Provider Demographics
NPI:1982647244
Name:WAY SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:WAY SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-247-4769
Mailing Address - Street 1:3025 BRECKINRIDGE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-7611
Mailing Address - Country:US
Mailing Address - Phone:678-226-0022
Mailing Address - Fax:
Practice Address - Street 1:210 PENNY LN
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4305
Practice Address - Country:US
Practice Address - Phone:252-247-4769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20985208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986054Medicaid
NC86054OtherNC BCBS NUMBER
NC230453Medicare PIN
NC86054OtherNC BCBS NUMBER