Provider Demographics
NPI:1093110447
Name:GAINESVILLE PROCEDURE CENTER LLC
Entity Type:Organization
Organization Name:GAINESVILLE PROCEDURE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWNETTA
Authorized Official - Middle Name:JANENE
Authorized Official - Last Name:HOLLADAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-989-1515
Mailing Address - Street 1:PO BOX 80307
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-0307
Mailing Address - Country:US
Mailing Address - Phone:706-549-8114
Mailing Address - Fax:706-549-7558
Practice Address - Street 1:601 BROAD ST SE
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3729
Practice Address - Country:US
Practice Address - Phone:678-989-1515
Practice Address - Fax:770-868-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical