1245295823 NPI number — ATLANTA SURGERY CENTER, LTD

Table of content: (NPI 1245295823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245295823 NPI number — ATLANTA SURGERY CENTER, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA SURGERY CENTER, LTD
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:
6
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:
1245295823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5505 PEACHTREE DUNWOODY RD NE
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-847-0893
Provider Business Mailing Address Fax Number:
404-843-8664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5505 PEACHTREE DUNWOODY RD NE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-847-0893
Provider Business Practice Location Address Fax Number:
404-843-8664
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIEDTKE
Authorized Official First Name:
DON
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
615-344-5507

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  060169 , 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: 000374162A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com