Healthcare Provider Details

I. General information

NPI: 1902852841
Provider Name (Legal Business Name): MIDTOWN UROLOGY SURGICAL CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 PIEDMONT RD NE
ATLANTA GA
30324-4117
US

IV. Provider business mailing address

1924 PIEDMONT RD NE
ATLANTA GA
30324-4117
US

V. Phone/Fax

Practice location:
  • Phone: 404-881-0966
  • Fax: 404-874-5902
Mailing address:
  • Phone: 404-881-0966
  • Fax: 404-874-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAMES KENT BENNETT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 404-881-0966