Healthcare Provider Details

I. General information

NPI: 1942413943
Provider Name (Legal Business Name): ROCK BRIDGE SURGICAL INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD SUITE 460
ROSWELL GA
30076-4975
US

IV. Provider business mailing address

PO BOX 100460
ATLANTA GA
30384-0460
US

V. Phone/Fax

Practice location:
  • Phone: 770-410-4661
  • Fax: 770-410-4664
Mailing address:
  • Phone: 770-410-4661
  • Fax: 770-410-4664

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: MR. MICHAEL KYLE BURTNETT
Title or Position: SVP OF OUTPATIENT SERVICES, TENET
Credential:
Phone: 469-893-2153