Provider Demographics
NPI:1134168883
Name:MERIDIAN SURGICAL, PC
Entity type:Organization
Organization Name:MERIDIAN SURGICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUJ
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-704-6101
Mailing Address - Street 1:684 SIXES RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8721
Mailing Address - Country:US
Mailing Address - Phone:770-704-6101
Mailing Address - Fax:770-704-6316
Practice Address - Street 1:684 SIXES RD
Practice Address - Street 2:SUITE 225
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30115-8721
Practice Address - Country:US
Practice Address - Phone:770-704-6101
Practice Address - Fax:770-704-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053856208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA594877089BMedicaid
GA594877089BMedicaid