Healthcare Provider Details

I. General information

NPI: 1710290606
Provider Name (Legal Business Name): GEORGIA NEUROSURGICAL INSTITUTE OUTPATIENT SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 PINE ST SUITE 810
MACON GA
31201-2100
US

IV. Provider business mailing address

840 PINE ST SUITE 810
MACON GA
31201-2100
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-7092
  • Fax: 478-743-0523
Mailing address:
  • Phone: 478-743-7092
  • Fax: 478-743-0523

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: BERNADINE BELL
Title or Position: APPEAL DENIALS
Credential: AS, CPC, CBP, CPC-I
Phone: 478-743-7092