Healthcare Provider Details

I. General information

NPI: 1427307578
Provider Name (Legal Business Name): HEMLOCK AMBULATORY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PRESTON CT STE 104
MACON GA
31210-5771
US

IV. Provider business mailing address

101 PRESTON CT STE 104
MACON GA
31210-5771
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-2385
  • Fax: 478-745-1225
Mailing address:
  • Phone: 478-745-2385
  • Fax: 478-745-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number011-473
License Number StateGA

VIII. Authorized Official

Name: STEPHEN N TAFOR
Title or Position: CEO
Credential: M.D.
Phone: 478-745-2385