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General NPI Number Information
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NPI Number | 1316603699
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Entity Type | Organization
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Legal Business Name | HEATHROW SURGERY CENTER LLC
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Dates
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Enumeration Date | 11/11/2021
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 942 INTERNATIONAL PKWY
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City | LAKE MARY
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State | FL
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Zip | 32746-5219
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Country | US
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Telephone | 404-953-4095
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Fax | 404-410-1211
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Provider Business Mailing Address
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Address Line | 5775 GLENRIDGE DR STE 500
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City | ATLANTA
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State | GA
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Zip | 30328-5380
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | CANDICE BROWN DAVIS
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Credential |
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Telephone | 916-990-7590
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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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