Mppg, Inc.

NPI #1639247414 in Vidalia, Georgia

Provider Information

NPI Number: 1639247414
Entity Type: Organization
Organization Name: Mppg, Inc.
Primary Specialty: Colon & Rectal Surgery
Enumeration Date: Dec 1, 2006
Last Updated: Aug 15, 2012

Practice Location

Address: 200 MAPLE DRIVE
City: Vidalia
State: Georgia
ZIP Code: 30474
Phone: (912) 537-9851

Authorized Official

Name: ROBIN J. MADDOX
Title: PROVIDER ENROLLMENT COORDINATOR
Phone: (912) 350-9335

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Surgery	208600000X
Colon & Rectal Surgery	208C00000X	Primary

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