Provider Demographics
NPI:1447753173
Name:ADVANCED CENTER FOR JOINT SURGERY, LLC
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR JOINT SURGERY, LLC
Other - Org Name:NORTHSIDE ADVANCED JOINT SURGERY CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP ADMIN SRVS./CCO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-851-6378
Mailing Address - Street 1:1100 JOHNSON FY RD NE BLDG II
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 HOWARD FARM DRIVE
Practice Address - Street 2:SUITE T100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-3004
Practice Address - Country:US
Practice Address - Phone:470-839-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty