Provider Demographics
NPI:1750116380
Name:MAJOR SURGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:MAJOR SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:RALSTON
Authorized Official - Last Name:MAJOR
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:706-302-5556
Mailing Address - Street 1:PO BOX 96617
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28296-0617
Mailing Address - Country:US
Mailing Address - Phone:706-803-1800
Mailing Address - Fax:229-331-7178
Practice Address - Street 1:1075 LAFAYETTE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3733
Practice Address - Country:US
Practice Address - Phone:706-803-1800
Practice Address - Fax:229-331-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty