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General NPI Number Information
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NPI Number | 1659426385
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Entity Type | Organization
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Legal Business Name | FORSYTH STREET AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 1610 FORSYTH STREET
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City | MACON
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State | GA
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Zip | 31201
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Country | US
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Telephone | 478-749-1610
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Fax | 478-841-3150
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Provider Business Mailing Address
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Address Line | 1610 FORSYTH STREET
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City | MACON
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State | GA
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Zip | 31201
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Country | US
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Telephone | 478-749-1610
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Fax | 478-841-3150
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TAMMY MICHELLE HODGE
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Credential | RN
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Telephone | 478-749-1610
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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 | GA
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