Healthcare Provider Details

I. General information

NPI: 1508210378
Provider Name (Legal Business Name): APEX MEDICAL SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 LAFAYETTE PKWY STE 100
LAGRANGE GA
30241-3507
US

IV. Provider business mailing address

1075 LAFAYETTE PKWY STE 100
LAGRANGE GA
30241-3507
US

V. Phone/Fax

Practice location:
  • Phone: 706-443-5273
  • Fax: 762-323-1014
Mailing address:
  • Phone: 706-443-5273
  • Fax: 706-443-5275

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: MR. DAVIN G MITCHELL
Title or Position: OWNER
Credential: MD
Phone: 762-323-1030