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NPI Code Detail

MEDICARE: MIDTOWN UROLOGY SURGICAL CENTER, PC

MEDICARE: MIDTOWN UROLOGY SURGICAL CENTER, PC
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
1261QA1903XAmbulatory Surgical Clinic/CenterGA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902852841
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDTOWN UROLOGY SURGICAL CENTER, PC
Provider Business Mailing Address
First Line : 1924 PIEDMONT RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30324-4117
Country : US
Telephone Number : 404-881-0966
Fax Number : 404-874-5902
Provider Business Practice Location Address
First Line : 1924 PIEDMONT RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30324-4117
Country : US
Telephone Number : 404-881-0966
Fax Number : 404-874-5902
Authorized Official
Title or Position : PRESIDENT
Name : DR. JAMES KENT BENNETT
Credential : M.D.
Telephone Number : 404-881-0966
Provider Enumeration Date : 05/25/2006
Last Update Date : 07/21/2022

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1558812024 — GABRIELLA CONCETTA KARIMI PA-C
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1154102598 — MIDTOWN UROLOGY ANESTHESIA LLC
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