Provider Demographics
NPI:1881889871
Name:PIEDMONT REGIONAL SURGICAL
Entity type:Organization
Organization Name:PIEDMONT REGIONAL SURGICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-452-1024
Mailing Address - Street 1:PO BOX 1473
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1473
Mailing Address - Country:US
Mailing Address - Phone:478-452-1024
Mailing Address - Fax:478-452-0447
Practice Address - Street 1:750 N COBB ST STE 130
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7168
Practice Address - Country:US
Practice Address - Phone:478-452-1024
Practice Address - Fax:478-452-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6491OtherMEDICARE GROUP#