Healthcare Provider Details

I. General information

NPI: 1225457948
Provider Name (Legal Business Name): AHS SURGERY CENTER CANTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KIMBERLY WAY SUITE 100
CANTON GA
30114
US

IV. Provider business mailing address

3968 FELTON HILL RD SW SUITE 100
SMYRNA GA
30082-3512
US

V. Phone/Fax

Practice location:
  • Phone: 770-333-7888
  • Fax: 770-333-7889
Mailing address:
  • Phone: 770-333-7888
  • Fax: 770-333-7889

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: VIRALKUMAR PATEL
Title or Position: CEO
Credential: MD
Phone: 770-333-7888