Healthcare Provider Details

I. General information

NPI: 1215275227
Provider Name (Legal Business Name): ISPM ASC AT PIEDMONT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 02/29/2020
Certification Date: 02/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 PEACHTREE ROAD SUITE 225
ATLANTA GA
30309
US

IV. Provider business mailing address

P.O. BOX 11407 DEPT 2324
BIRMINGHAM AL
35246-2324
US

V. Phone/Fax

Practice location:
  • Phone: 770-929-9033
  • Fax: 770-929-9092
Mailing address:
  • Phone: 404-920-4950
  • Fax: 404-920-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: VICTORIA BECK
Title or Position: CFO
Credential:
Phone: 404-920-4950