Healthcare Provider Details

I. General information

NPI: 1588620306
Provider Name (Legal Business Name): SPECIALTY ORTHOPAEDICS SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 JESSE JEWELL PKWY SE SUITE 360
GAINESVILLE GA
30501-3862
US

IV. Provider business mailing address

1240 JESSE JEWELL PKWY SE SUITE 360
GAINESVILLE GA
30501
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-9420
  • Fax: 678-450-3755
Mailing address:
  • Phone: 770-534-9420
  • Fax: 678-450-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number069-309
License Number StateGA

VIII. Authorized Official

Name: MS. KAYE WILLIAMS
Title or Position: BILLING SUPERVISOR
Credential: CPC
Phone: 770-534-7200