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General NPI Number Information
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NPI Number | 1457758450
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Entity Type | Organization
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Legal Business Name | ADVANCED AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 12389 CRABAPPLE RD
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City | ALPHARETTA
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State | GA
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Zip | 30004-6328
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Country | US
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Telephone | 470-299-1998
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Fax | 470-299-1898
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Provider Business Mailing Address
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Address Line | 4129 STEINHAUER RD NE
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City | MARIETTA
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State | GA
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Zip | 30066-2213
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Country | US
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Telephone | 470-299-1998
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Fax | 470-299-1898
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Authorized Official
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Title or Position | OWNER
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Name | WOODLEY BERNADETTE MARDY-DAVIS
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Credential | MD
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Telephone | 470-299-1998
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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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