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General NPI Number Information
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NPI Number | 1104072453
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Entity Type | Organization
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Legal Business Name | MACON OUTPATIENT SURGERY INC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 3708 NORTHSIDE DR
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City | MACON
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State | GA
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Zip | 31210-2404
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Country | US
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Telephone | 478-745-4206
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Fax | 478-254-5463
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Provider Business Mailing Address
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Address Line | 3708 NORTHSIDE DR
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City | MACON
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State | GA
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Zip | 31210-2404
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Country | US
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Telephone | 478-745-4206
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Fax | 478-254-5463
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | GEORGIA LEE
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Credential |
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Telephone | 478-745-4206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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