Healthcare Provider Details

I. General information

NPI: 1780854489
Provider Name (Legal Business Name): SUMMERVILLE SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 STOVALL ST
AUGUSTA GA
30904-4883
US

IV. Provider business mailing address

1433 STOVALL ST
AUGUSTA GA
30904-4883
US

V. Phone/Fax

Practice location:
  • Phone: 706-736-6806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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. WILLIAM JOSEPH WELSH
Title or Position: CHIEF MEDICAL DIRECTOR
Credential:
Phone: 706-736-6806