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NPI Code Detail

MEDICARE: GEORGIA AMBULATORY SURGERY CENTER LLC

MEDICARE: GEORGIA AMBULATORY SURGERY CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/CenterGA

General Provider Information

NPI Number : 1205374022
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGIA AMBULATORY SURGERY CENTER LLC
Provider Business Mailing Address
First Line : PO BOX 527
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-0527
Country : US
Telephone Number : 770-979-0900
Fax Number : 770-979-2852
Provider Business Practice Location Address
First Line : 2175 NORTH RD
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2630
Country : US
Telephone Number : 770-979-0900
Fax Number : 770-979-2852
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. DORIAN JIMENEZ
Credential : DPM
Telephone Number : 770-979-0900
Provider Enumeration Date : 02/01/2017
Last Update Date : 02/01/2017

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