MEDICARE: LUMPKIN SURGERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1265709968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMPKIN SURGERY CENTER

Provider Business Mailing Address
First Line	:	1300 CRYSTAL HILLS DR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-5304
Country	:	US
Telephone Number	:	706-254-1009
Fax Number	:	706-353-2552

Provider Business Practice Location Address
First Line	:	1300 CRYSTAL HILLS DR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-5304
Country	:	US
Telephone Number	:	706-254-1009
Fax Number	:	706-353-2552

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLINTON ASHFORD
Credential	:	MD
Telephone Number	:	706-254-1009

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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