MEDICARE: MILTON HALL 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	060-137	GA

General Provider Information

NPI Number	:	1619004306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILTON HALL SURGERY CENTER

Provider Business Mailing Address
First Line	:	2365 OLD MILTON PKWY
Second Line	:	SUITE 200
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2140
Country	:	US
Telephone Number	:	770-740-1860
Fax Number	:	678-347-2104

Provider Business Practice Location Address
First Line	:	2365 OLD MILTON PKWY
Second Line	:	SUITE 200
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2140
Country	:	US
Telephone Number	:	770-740-1860
Fax Number	:	678-347-2104

Authorized Official
Title or Position	:	CEO
Name	:	DR. JEFFREY M GALLUPS
Credential	:	M.D.
Telephone Number	:	770-740-1860

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	11/30/2010

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