Organization
NORTHSIDE SURGICAL ASSOCIATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSA L LANGELLA M.D. (CO OWNER)
(706) 692-9081
Entity
Organization
Contact information
Practice address
80 INTERSTATE SOUTH DR, STE B, JASPER, GA 30143-6226
(706) 692-9081
(706) 692-0155
Mailing address
80 INTERSTATE SOUTH DR, STE B, JASPER, GA 30143-6226
(706) 692-9081
(706) 692-0155
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300021256A
—
GA
01
—
H9749
RAILROAD MEDICARE GROUP
GA
Enumeration date
11/21/2006
Last updated
05/22/2008
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