1881612042 NPI number — THE HAND AND UPPER EXTREMITY SURGERY CENTER OF GEORGIA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881612042 NPI number — THE HAND AND UPPER EXTREMITY SURGERY CENTER OF GEORGIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HAND AND UPPER EXTREMITY SURGERY CENTER OF GEORGIA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881612042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
993-D JOHNSON FERRY ROAD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-969-1996
Provider Business Mailing Address Fax Number:
404-969-1999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
993-D JOHNSON FERRY ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-969-1996
Provider Business Practice Location Address Fax Number:
404-969-1999
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
VICE PRESIDENT, ADMIN SERVICES/CCO
Authorized Official Telephone Number:
404-851-6378

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  060-293 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: T1667 . This is a "KAISER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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