Healthcare Provider Details

I. General information

NPI: 1467833160
Provider Name (Legal Business Name): AUSTELL SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 MULKEY RD
AUSTELL GA
30106-1186
US

IV. Provider business mailing address

1610 MULKEY RD
AUSTELL GA
30106-1186
US

V. Phone/Fax

Practice location:
  • Phone: 770-544-0444
  • Fax: 678-239-0994
Mailing address:
  • Phone: 678-426-2188
  • Fax: 770-874-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID N HELFMAN
Title or Position: CEO
Credential: DPM
Phone: 678-426-2171