Organization
THE WIREGRASS MEDICAL & SURGICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
APRIL CLANTON MASSEY (PRACTICE ADMINISTRATOR)
(229) 524-2706
Entity
Organization
Contact information
Practice address
804 N WILEY AVE, DONALSONVILLE, GA 39845-1120
(229) 524-2706
(229) 524-1272
Mailing address
804 N WILEY AVE, DONALSONVILLE, GA 39845-1120
(229) 524-2706
(229) 524-1272
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
051586
GA
207R00000X
Internal Medicine Physician
033591
GA
208600000X
Surgery Physician
019644
GA
208600000X
Surgery Physician
9288
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP8001
MEDICARE GROUP NUMBER
GA
Enumeration date
02/05/2007
Last updated
06/21/2018
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