Healthcare Provider Details

I. General information

NPI: 1700093044
Provider Name (Legal Business Name): ASSOCIATED FOOT AND ANKLE AMBULATORY SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1854 FORSYTH ST SUITE 3
MACON GA
31201-1169
US

IV. Provider business mailing address

1854 FORSYTH ST SUITE 3
MACON GA
31201-1169
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-2600
  • Fax: 478-742-5657
Mailing address:
  • Phone: 478-745-2600
  • Fax: 478-742-5657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number011-175
License Number StateGA

VIII. Authorized Official

Name: DR. PAUL G SMAHA II
Title or Position: MEDICAL DIRECTOR
Credential: DPM
Phone: 478-745-2600