Provider Demographics
NPI:1114081635
Name:NORTH GEORGIA OUTPATIENT SURGERY CENTER INC
Entity Type:Organization
Organization Name:NORTH GEORGIA OUTPATIENT SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOSMAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-629-1852
Mailing Address - Street 1:795 RED BUD RD NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1966
Mailing Address - Country:US
Mailing Address - Phone:706-629-1852
Mailing Address - Fax:706-629-8004
Practice Address - Street 1:795 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1966
Practice Address - Country:US
Practice Address - Phone:706-629-1852
Practice Address - Fax:706-629-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA064-078261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA51001641-002OtherBLUE CROSS BLUE SHIELD
GA590008544OtherRAILROAD MEDICARE
GA00586506AMedicaid
GA590008544OtherRAILROAD MEDICARE