Elite Surgical PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

024628 Issued in GA

Legal business name

ELITE SURGICAL PC

Practice address

3969 S Cobb Dr SE Ste 202
Smyrna, GA 30080-6317

Phone

(770) 438-9191

Fax

(770) 438-9272

NPI assigned

Nov 18, 2013

Last updated

Jan 15, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Baheeg Lawrence Shadeed, M.D.NPI 1275620205

Title

Owner

Phone

(770) 438-9191

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Baheeg L Shadeed MD Other name

Locations

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.

• Baheeg L Shadeed, M.D.

  • Surgery Physician
  • Smyrna, GA
  • NPI 1275620205
  Authorized official Same address or phone

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

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389744000000",
    "number": "1588094106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3969 S COBB DR SE STE 202",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300806317",
            "telephone_number": "770-438-9191",
            "fax_number": "770-438-9272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3969 S COBB DR SE STE 202",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300806317",
            "telephone_number": "770-438-9191",
            "fax_number": "770-438-9272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE SURGICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-18",
        "last_updated": "2014-01-15",
        "status": "A",
        "authorized_official_last_name": "SHADEED",
        "authorized_official_first_name": "BAHEEG",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-438-9191",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "024628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000261665B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baheeg L Shadeed MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; 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.