Provider Demographics
NPI:1700157880
Name:NORTH GEORGIA SURGICAL GROUP LLC
Entity Type:Organization
Organization Name:NORTH GEORGIA SURGICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:LUMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-278-0351
Mailing Address - Street 1:1801 HUNTINGTON WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3838
Mailing Address - Country:US
Mailing Address - Phone:706-248-0351
Mailing Address - Fax:
Practice Address - Street 1:1504 N THORNTON AVE
Practice Address - Street 2:SUITE 101B
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8394
Practice Address - Country:US
Practice Address - Phone:706-278-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020574208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01281439OtherAMERIGROUP
GAN0503836OtherWELLCARE
GA000180353CMedicaid
GA000180353CMedicaid
GA000180353CMedicaid