Provider Demographics
NPI:1801926886
Name:MCDUFFIE SURGICAL CLINIC PC
Entity type:Organization
Organization Name:MCDUFFIE SURGICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-595-9950
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-1148
Mailing Address - Country:US
Mailing Address - Phone:706-595-9950
Mailing Address - Fax:706-597-8820
Practice Address - Street 1:2512 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-0040
Practice Address - Country:US
Practice Address - Phone:706-595-9950
Practice Address - Fax:706-597-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033003208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP3214Medicare ID - Type UnspecifiedMEDICARE CORP NO.