NPIMap

Organization Active NPI

Elberton Surgical LLC

  • Specialist
  • Elberton, GA
National Provider Identifier
1154489383
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
031754 Issued in GA
Legal business name
ELBERTON SURGICAL LLC
Practice address
4 Medical Drive
4TH Floor
Elberton, GA 30635-1830
Phone
(706) 213-6618
Fax
(706) 283-6124
NPI assigned
Dec 4, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. William Kendric Haley, M.D.NPI 1598794109
Title
Managing Member
Phone
(706) 213-6618

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 031754 GA Primary

Addresses

Primary practice location

4 Medical Drive
4TH Floor
Elberton, GA 30635-1830

Mailing address

4 Medical Dr
4TH Floor
Elberton, GA 30635-1830
Phone (706) 213-6618

Other names 1

  • DR WILLIAM HALEY Other name

National Provider Directory

National Provider Directory

Locations

4 Medical Dr
Fl 4
Elberton, GA 30635
Phone (706) 213-6618

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154489383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MEDICAL DR",
            "address_2": "4TH FLOOR",
            "city": "ELBERTON",
            "state": "GA",
            "postal_code": "306351830",
            "telephone_number": "706-213-6618",
            "fax_number": "706-283-6124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEDICAL DRIVE",
            "address_2": "4TH FLOOR",
            "city": "ELBERTON",
            "state": "GA",
            "postal_code": "306351830",
            "telephone_number": "706-213-6618",
            "fax_number": "706-283-6124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELBERTON SURGICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HALEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "KENDRIC",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "706-213-6618",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "031754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DR WILLIAM HALEY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Elberton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.