NPIMap

Organization Active NPI

Northeast Georgia Surgical Associates PC

  • Specialist
  • Gainesville, GA
National Provider Identifier
1497861900
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
NORTHEAST GEORGIA SURGICAL ASSOCIATES PC
Practice address
1075 Jesse Jewell Pkwy NE Ste B
Gainesville, GA 30501-3814
Phone
(770) 536-5733
Fax
(770) 532-8007
NPI assigned
Aug 21, 2006
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
Mrs. Gail Detraz
Title
Administrator
Phone
(770) 536-5733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1075 Jesse Jewell Pkwy NE Ste B
Gainesville, GA 30501-3814

Mailing address

1075 Jesse Jewell Pkwy NE Ste B
Gainesville, GA 30501-3814
Phone (770) 536-5733

National Provider Directory

National Provider Directory

Locations

1075 Jesse Jewell Pkwy NE
Ste B
Gainesville, GA 30501
Phone (770) 219-9200

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497861900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 JESSE JEWELL PKWY NE STE B",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013814",
            "telephone_number": "770-536-5733",
            "fax_number": "770-532-8007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 JESSE JEWELL PKWY NE STE B",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013814",
            "telephone_number": "770-536-5733",
            "fax_number": "770-532-8007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA SURGICAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DETRAZ",
        "authorized_official_first_name": "GAIL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "770-536-5733",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, 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.