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Organization

FAYETTE SURGICAL ASSOCIATES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DIANA LOWERY (OFFICE MANAGER)
(770) 719-5660
Entity
Organization

Contact information

Practice address
1265 HIGHWAY 54 W, SUITE 500B, FAYETTEVILLE, GA 30214-4548
(770) 719-5660
(678) 817-4339
Mailing address
1265 HIGHWAY 54 W, SUITE 500B, FAYETTEVILLE, GA 30214-4548
(770) 719-5660
(678) 817-4339

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DA6744
RAILROAD MEDICARE
GA
Enumeration date
11/09/2007
Last updated
12/13/2007
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