Healthcare Provider Details

I. General information

NPI: 1104987957
Provider Name (Legal Business Name): EYE SURGERY CENTER OF AUGUSTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3658 J DEWEY GRAY CIR
AUGUSTA GA
30909-6424
US

IV. Provider business mailing address

3658 J DEWEY GRAY CIR
AUGUSTA GA
30909-6424
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-3937
  • Fax: 706-863-3102
Mailing address:
  • Phone: 706-651-2020
  • Fax: 706-651-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number121167
License Number StateGA

VIII. Authorized Official

Name: BRUCE ALLEN BROWN
Title or Position: PRESIDENT
Credential:
Phone: 706-651-2020