Elberton Surgical LLC

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

Organization subpart

No

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.

Title

Managing Member

Phone

(706) 213-6618

Specialties & licenses 1

Addresses

Other names 1

• DR WILLIAM HALEY Other name

Locations

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"
        }
    ]
}

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• Specialist in Elberton, GA
• Providers in Elberton, GA by specialty
• Specialist in Georgia

• 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.