Provider Demographics
NPI:1336104926
Name:ATLANTA SURGERY CENTER LTD
Entity Type:Organization
Organization Name:ATLANTA SURGERY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:5730 GLENRIDGE DR NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6141
Mailing Address - Country:US
Mailing Address - Phone:404-252-3074
Mailing Address - Fax:404-252-4775
Practice Address - Street 1:5730 GLENRIDGE DR NE
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6141
Practice Address - Country:US
Practice Address - Phone:404-252-3074
Practice Address - Fax:404-252-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060032261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000355671AMedicaid
GA000355671AMedicaid