Provider Demographics
NPI:1295880763
Name:SUMMIT SURGICAL SPECIALISTS PC
Entity type:Organization
Organization Name:SUMMIT SURGICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-423-0395
Mailing Address - Street 1:590 NANCY ST NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1334
Mailing Address - Country:US
Mailing Address - Phone:770-423-0395
Mailing Address - Fax:770-499-0352
Practice Address - Street 1:590 NANCY ST NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1334
Practice Address - Country:US
Practice Address - Phone:770-423-0395
Practice Address - Fax:770-499-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55001233AMedicaid
GA55001233AMedicaid