Basic Information
| Provider Information | |||||||||
| NPI: | 1215082490 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH WEST GEORGIA SURGICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1628 | ||||||||
| Address2: | |||||||||
| City: | CALHOUN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307031628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066028300 | ||||||||
| FaxNumber: | 7066256955 | ||||||||
| Practice Location | |||||||||
| Address1: | 1035 RED BUD RD NE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | CALHOUN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307012082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066028300 | ||||||||
| FaxNumber: | 7066256955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 10/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | THEUS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7066028300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.