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General NPI Number Information
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NPI Number | 1114984523
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Entity Type | Organization
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Legal Business Name | AUGUSTA UROLOGY SURGICENTER, LLC
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 811 13TH STREET, SUITE 17
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City | AUGUSTA
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State | GA
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Zip | 30901-2700
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Country | US
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Telephone | 706-724-4111
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Fax | 706-823-0533
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Provider Business Mailing Address
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Address Line | 811 13TH STREET, SUITE 17
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City | AUGUSTA
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State | GA
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Zip | 30901-2700
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Country | US
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Telephone | 706-724-4111
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Fax | 706-823-0533
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. LINDA G. FLOWERS
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Credential |
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Telephone | 706-724-4111
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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 | 121-153
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License Number State | GA
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