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Organization
MPPG, INC.
Active
Organization
MPPG, INC.
Active
Other names
Cardiovascular & Thoracic Surgery Association
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
4750 WATERS AVE, SUITE 452, SAVANNAH, GA 31404-6200
(912) 354-7188
(912) 354-5208
Mailing address
PO BOX 102032, ATLANTA, GA 30368-2032
(912) 354-7188
(912) 354-5208
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300031676A
—
GA
01
—
CH5121
RAILROAD MEDICARE GROUP
GA
05
—
GPA594
—
SC
Enumeration date
12/13/2006
Last updated
05/31/2011
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