NPIMap

Organization Active NPI

Eagles Landing Surgery, P.C.

  • Surgery Physician
  • Stockbridge, GA
National Provider Identifier
1154551174
Registry record updated Jul 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
034109 Issued in GA
Legal business name
EAGLES LANDING SURGERY, P.C.
Practice address
245 Village Center Pkwy
Suite 100
Stockbridge, GA 30281-9096
Phone
(770) 389-1962
Fax
(770) 389-0494
NPI assigned
Jul 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2009

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

Authorized official

Name
Mrs. Robin Wall, RN
Title
Registered Nurse
Phone
(770) 389-1962

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 034109 GA Primary

Addresses

Primary practice location

245 Village Center Pkwy
Suite 100
Stockbridge, GA 30281-9096

Mailing address

245 Village Center Pkwy
Suite 100
Stockbridge, GA 30281-9096
Phone (770) 389-1962

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1248393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248393600000",
    "number": "1154551174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 VILLAGE CENTER PKWY",
            "address_2": "SUITE 100",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819096",
            "telephone_number": "770-389-1962",
            "fax_number": "770-389-0494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 VILLAGE CENTER PKWY",
            "address_2": "SUITE 100",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819096",
            "telephone_number": "770-389-1962",
            "fax_number": "770-389-0494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLES LANDING SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-24",
        "last_updated": "2009-07-24",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "REGISTERED NURSE",
        "authorized_official_telephone_number": "770-389-1962",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "GA",
            "license": "034109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2009; 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.