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General NPI Number Information
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NPI Number | 1164664595
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Entity Type | Organization
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Legal Business Name | ALPHARETTA HEAD AND NECK SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 1360 UPPER HEMBREE RD SUITE 202
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City | ROSWELL
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State | GA
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Zip | 30076-1171
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Country | US
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Telephone | 404-256-7532
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Fax | 404-252-8781
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Provider Business Mailing Address
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Address Line | 5730 GLENRIDGE DR NE SUITE 220
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City | ATLANTA
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State | GA
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Zip | 30328-6141
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Country | US
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Telephone | 404-256-7532
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Fax | 404-252-8781
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW J DIAMOND
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Credential | MD
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Telephone | 404-256-7532
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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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