Organization
SURGICAL PRACTICE FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY PEED (CEO)
(478) 825-8691
Entity
Organization
Contact information
Practice address
701 BLUEBIRD BLVD, FORT VALLEY, GA 31030-5085
(478) 825-7000
(478) 825-4485
Mailing address
701 BLUEBIRD BLVD, FORT VALLEY, GA 31030-5085
(478) 825-7000
(478) 825-4485
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
04/02/2009
Last updated
04/02/2009
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