Provider Demographics
NPI:1730417411
Name:ATLANTIC SURGERY, PLLC
Entity type:Organization
Organization Name:ATLANTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-449-9120
Mailing Address - Street 1:4917 S CROATAN HWY
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-8811
Mailing Address - Country:US
Mailing Address - Phone:252-449-9120
Mailing Address - Fax:252-449-9119
Practice Address - Street 1:4917 S CROATAN HWY
Practice Address - Street 2:SUITE 1-C
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8811
Practice Address - Country:US
Practice Address - Phone:252-449-9120
Practice Address - Fax:252-449-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01841208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORI11409Medicare UPIN