Healthcare Provider Details

I. General information

NPI: 1558131656
Provider Name (Legal Business Name): SUBURBAN RETINA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4989 PEACHTREE PKWY STE 111
PEACHTREE CORNERS GA
30092-2589
US

IV. Provider business mailing address

4989 PEACHTREE PKWY STE 111
PEACHTREE CORNERS GA
30092-2589
US

V. Phone/Fax

Practice location:
  • Phone: 770-246-1335
  • Fax:
Mailing address:
  • Phone: 770-246-1335
  • Fax:

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: RISHI SINGHAL
Title or Position: OWNER
Credential: MD
Phone: 770-240-1335