Provider Demographics
NPI:1447340872
Name:STAT SURGICAL SERVICES OF MACON, LLC
Entity type:Organization
Organization Name:STAT SURGICAL SERVICES OF MACON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CRNFA
Authorized Official - Phone:478-986-6825
Mailing Address - Street 1:827 PITTS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-2327
Mailing Address - Country:US
Mailing Address - Phone:478-986-6825
Mailing Address - Fax:478-986-6825
Practice Address - Street 1:827 PITTS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-2327
Practice Address - Country:US
Practice Address - Phone:478-986-6825
Practice Address - Fax:478-986-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN039858163WR0006X
GARN047391163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
600951600OtherUS DEPARTMENT OF TREASURY
GA52207252OtherBLUE CROSS/BLUE SHIELD
GA52268332OtherBLUE CROSS/BLUE SHIELD