Healthcare Provider Details

I. General information

NPI: 1639179914
Provider Name (Legal Business Name): SOUTHERN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 VERNON RD SUITE C
LAGRANGE GA
30240-4041
US

IV. Provider business mailing address

1805 VERNON RD SUITE C
LAGRANGE GA
30240-4041
US

V. Phone/Fax

Practice location:
  • Phone: 706-812-9902
  • Fax:
Mailing address:
  • Phone: 706-812-9902
  • Fax: 706-812-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number141-136
License Number StateGA

VIII. Authorized Official

Name: DR. DANIEL K GUY
Title or Position: CEO
Credential: MD
Phone: 706-812-9902