Healthcare Provider Details

I. General information

NPI: 1477788727
Provider Name (Legal Business Name): WOOLFSON AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MOUNT VERNON HWY SUITE 100
ATLANTA GA
30328-4295
US

IV. Provider business mailing address

800 MOUNT VERNON HWY SUITE 120
ATLANTA GA
30328-4295
US

V. Phone/Fax

Practice location:
  • Phone: 404-237-1770
  • Fax: 404-237-6002
Mailing address:
  • Phone: 770-804-1684
  • Fax: 770-804-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN M. WOOLFSON
Title or Position: CEO/PHYSICIAN
Credential: MD
Phone: 404-237-6002