Healthcare Provider Details

I. General information

NPI: 1548223068
Provider Name (Legal Business Name): COLUMBIA SURGICARE OF AUGUSTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 RUSSELL ST
AUGUSTA GA
30904-4115
US

IV. Provider business mailing address

915 RUSSELL ST
AUGUSTA GA
30904-4115
US

V. Phone/Fax

Practice location:
  • Phone: 706-738-4925
  • Fax: 706-738-7224
Mailing address:
  • Phone: 706-738-4925
  • Fax: 706-738-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number121022
License Number StateGA

VIII. Authorized Official

Name: WILLIAM GREGORY SWINNEY
Title or Position: VP
Credential:
Phone: 972-789-2877