MEDICARE: NORTHSIDE DUNWOODY OUTPATIENT 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	:	1649486796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSIDE DUNWOODY OUTPATIENT SURGERY CENTER

Provider Business Mailing Address
First Line	:	4553 N SHALLOWFORD RD
Second Line	:	SUITE 60C
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6408
Country	:	US
Telephone Number	:	770-457-6303
Fax Number	:

Provider Business Practice Location Address
First Line	:	4553 N SHALLOWFORD RD
Second Line	:	SUITE 60C
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6408
Country	:	US
Telephone Number	:	770-457-6303
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. WILLIAM E SILVER
Credential	:	M.D.
Telephone Number	:	770-457-6303

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	05/14/2008

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