Provider Demographics
NPI:1366412710
Name:MEREDYTH SURGERY CENTER, PC
Entity type:Organization
Organization Name:MEREDYTH SURGERY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-432-7012
Mailing Address - Street 1:2709 MEREDYTH DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0222
Mailing Address - Country:US
Mailing Address - Phone:229-432-7012
Mailing Address - Fax:229-435-0211
Practice Address - Street 1:2709 MEREDYTH DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0222
Practice Address - Country:US
Practice Address - Phone:229-432-7012
Practice Address - Fax:229-435-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111270ASCAMedicare ID - Type Unspecified