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General NPI Number Information
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NPI Number | 1881911451
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER OF BJI, LLC
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Dates
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Enumeration Date | 04/22/2010
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 112 PROFESSIONAL COURT
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City | JESUP
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State | GA
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Zip | 31545
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Country | US
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Telephone | 912-427-0800
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Fax | 912-427-6029
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Provider Business Mailing Address
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Address Line | PO BOX 1334
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City | JESUP
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State | GA
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Zip | 31598-1334
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Country | US
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Telephone | 912-427-0800
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Fax | 912-427-6029
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Authorized Official
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Title or Position | OWNER/SURGEON
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Name | JOHN MATTHEW VALOSEN
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Credential | MD
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Telephone | 912-427-0800
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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 | 30633
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License Number State | GA
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