Provider Demographics
NPI:1861527616
Name:SURGERY SOUTH PC
Entity type:Organization
Organization Name:SURGERY SOUTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO SURGERY SOUTH PC
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-474-7287
Mailing Address - Street 1:1040 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9072
Mailing Address - Country:US
Mailing Address - Phone:770-474-7287
Mailing Address - Fax:770-389-3713
Practice Address - Street 1:1040 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9072
Practice Address - Country:US
Practice Address - Phone:770-474-7287
Practice Address - Fax:770-389-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02BDGTPMedicare PIN
GA02BDDXGMedicare PIN
GA511I020107Medicare PIN
GA02BBCHDMedicare PIN