Provider Demographics
NPI:1649342874
Name:PIEDMONT SURGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:PIEDMONT SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAFER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALERIAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-5959
Mailing Address - Street 1:95 COLLIER RD NW
Mailing Address - Street 2:SUITE 6015
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1796
Mailing Address - Country:US
Mailing Address - Phone:404-351-5959
Mailing Address - Fax:404-351-8526
Practice Address - Street 1:95 COLLIER RD NW
Practice Address - Street 2:SUITE 6015
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1796
Practice Address - Country:US
Practice Address - Phone:404-351-5959
Practice Address - Fax:404-351-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2281Medicare ID - Type Unspecified