Healthcare Provider Details

I. General information

NPI: 1184987737
Provider Name (Legal Business Name): ORTHOPAEDIC SURGERY CENTER OF RALEIGH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 EDWARDS MILL RD # 100
RALEIGH NC
27612-5243
US

IV. Provider business mailing address

3001 EDWARDS MILL RD # 100
RALEIGH NC
27612-5243
US

V. Phone/Fax

Practice location:
  • Phone: 919-719-3070
  • Fax: 919-719-3086
Mailing address:
  • Phone: 919-719-3070
  • Fax: 919-719-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. GEORGE HADLEY CALLAWAY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 919-719-3070