Northside Surgical Associate
Organization Active NPI Surgery Physician · Jasper, GA
NPI 1740355338 · NPPES record last updated May 22, 2008
Key facts
- NPI
- 1740355338
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- NORTHSIDE SURGICAL ASSOCIATE
- Practice address
- 80 Interstate South Dr
Ste B
Jasper, GA 30143-6226 - Phone
- (706) 692-9081
- Fax
- (706) 692-0155
- NPI assigned
- Nov 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Rosa L Langella, M.D.
- Title
- Co Owner
- Phone
- (706) 692-9081
Practitioners 5
-
Roy Chu, M.D.
-
Louis A Goehring III, M.D.
-
Bradley Dwayne Hare, M.D.
-
Kenneth S Jago, MD
National Provider Directory
Locations
125 Oakside Ct
Ste 101
Canton, GA 30114
Phone (770) 479-3424
80 Fairview Rd
Ste B
Jasper, GA 30143
Phone (706) 253-2230
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | GA | Yes |
Addresses
Primary practice location
80 Interstate South Dr
Ste B
Jasper, GA 30143-6226
Mailing address
80 Interstate South Dr
Ste B
Jasper, GA 30143-6226
Phone (706) 692-9081
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H9749 | Other | GA | RAILROAD MEDICARE GROUP |
| 300021256A | Medicaid | GA |
Other providers in Jasper, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.