Healthcare Provider Details

I. General information

NPI: 1942548870
Provider Name (Legal Business Name): ISPM ASC AT CAMP CREEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 02/29/2020
Certification Date: 02/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 PRINCETON LAKES WAY SW STE 400
ATLANTA GA
30331-5589
US

IV. Provider business mailing address

PO BOX 11407 DEPT 2330
BIRMINGHAM AL
35246-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-920-4950
  • Fax: 404-920-4959
Mailing address:
  • Phone: 404-920-4950
  • Fax: 404-920-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROBIN JAMES FOWLER
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 404-920-4950