Provider Demographics
NPI:1437250248
Name:GEORGIA SURGICAL CENTER ON PEACHTREE, LLC
Entity Type:Organization
Organization Name:GEORGIA SURGICAL CENTER ON PEACHTREE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-528-1418
Mailing Address - Street 1:2061 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1427
Mailing Address - Country:US
Mailing Address - Phone:404-352-3522
Mailing Address - Fax:404-601-1235
Practice Address - Street 1:2061 PEACHTREE RD NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1444
Practice Address - Country:US
Practice Address - Phone:404-352-3522
Practice Address - Fax:404-601-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA077798LGB261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111155ASCAMedicare ID - Type Unspecified
GAX42893Medicare UPIN