Provider Demographics
NPI:1164664595
Name:ALPHARETTA HEAD AND NECK SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:ALPHARETTA HEAD AND NECK SURGICAL CENTER, LLC
Other - Org Name:ALPHARETTA HEAD AND NECK SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-256-7532
Mailing Address - Street 1:5730 GLENRIDGE DR NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6141
Mailing Address - Country:US
Mailing Address - Phone:404-256-7532
Mailing Address - Fax:404-252-8781
Practice Address - Street 1:1360 UPPER HEMBREE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1171
Practice Address - Country:US
Practice Address - Phone:404-256-7532
Practice Address - Fax:404-252-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical