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General NPI Number Information
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NPI Number | 1427307578
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Entity Type | Organization
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Legal Business Name | HEMLOCK AMBULATORY SURGERY CENTER
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 101 PRESTON CT STE 104
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City | MACON
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State | GA
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Zip | 31210-5771
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Country | US
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Telephone | 478-745-2385
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Fax | 478-745-1225
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Provider Business Mailing Address
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Address Line | 101 PRESTON CT STE 104
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City | MACON
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State | GA
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Zip | 31210-5771
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Country | US
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Telephone | 478-745-2385
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Fax | 478-745-1225
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Authorized Official
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Title or Position | CEO
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Name | STEPHEN N TAFOR
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Credential | M.D.
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Telephone | 478-745-2385
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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 | 011-473
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License Number State | GA
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