Healthcare Provider Details

I. General information

NPI: 1881832434
Provider Name (Legal Business Name): AHP OF CENTRAL FLORIDA ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3079 PEACHTREE INDUSTRIAL BLVD
DULUTH GA
30097-2215
US

IV. Provider business mailing address

3079 PEACHTREE INDUSTRIAL BLVD
DULUTH GA
30097-2215
US

V. Phone/Fax

Practice location:
  • Phone: 770-945-5330
  • Fax:
Mailing address:
  • Phone: 770-945-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GREG WACKOWIAK
Title or Position: PRESIDENT
Credential:
Phone: 770-945-5330