1992708929 NPI number — NOVAMED MANAGEMENT SERVICES LLC

Table of content: (NPI 1992708929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992708929 NPI number — NOVAMED MANAGEMENT SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
NOVAMED MANAGEMENT SERVICES 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:
ATLANTA EYE SURGERY CENTER
Provider Other Organization Name Type Code:
3
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:
1992708929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 DOWNWOOD CIR NW
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:
30327-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-351-1990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 DOWNWOOD CIR NW
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30327-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-351-1990
Provider Business Practice Location Address Fax Number:
404-355-8797
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MACOMBER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
312-664-4100

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  060-209 , 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: 490004881 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000890667A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00164715 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".