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General NPI Number Information
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NPI Number | 1609140151
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Entity Type | Organization
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Legal Business Name | ATLANTA ADVANCED SURGERY CENTER, LLC
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 5505 PEACHTREE DUNWOODY RD NE SUITE 150
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City | ATLANTA
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State | GA
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Zip | 30342-1705
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Country | US
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Telephone | 404-851-8000
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Fax | 404-845-5624
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Provider Business Mailing Address
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Address Line | 1000 JOHNSON FERRY RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-1606
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Country | US
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Telephone | 404-851-8000
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Fax | 404-845-5624
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Authorized Official
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Title or Position | VP ADMINISTRATIVE SERVICES, CCO
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Name | MR. JORGE J HERNANDEZ
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Credential |
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Telephone | 404-851-6378
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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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