Organization
CARROLLTON SURGICAL GROUP, P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN M ZEIS (PRACTICE ADMINISTRATOR)
(770) 834-3336
Entity
Organization
Contact information
Practice address
209 MAIN ST S, WEDOWEE, AL 36278-5139
(770) 834-3336
(770) 832-2331
Mailing address
157 CLINIC AVE, SUITE 302, CARROLLTON, GA 30117-4454
(770) 834-3336
(770) 832-2331
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55001589A
—
GA
01
—
CB2397
MEDICARE RRY
GA
Enumeration date
06/26/2007
Last updated
08/22/2020
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