Organization
LTHW SURGICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL SHOTWELL M.D. (OPERATING MANAGER)
(678) 840-2575
Entity
Organization
Contact information
Practice address
110 EVANS MILL DR, SUITE 401, DALLAS, GA 30157-1622
(678) 840-2575
Mailing address
110 EVANS MILL DR, SUITE 401, DALLAS, GA 30157-1622
(678) 840-2575
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
053168
GA
Other
Enumeration date
12/11/2012
Last updated
12/11/2012
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