Provider Demographics
NPI:1477651610
Name:SURGICAL CENTER FOR UROLOGY LLC
Entity Type:Organization
Organization Name:SURGICAL CENTER FOR UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-474-5281
Mailing Address - Street 1:290 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9069
Mailing Address - Country:US
Mailing Address - Phone:678-565-1806
Mailing Address - Fax:678-565-1904
Practice Address - Street 1:290 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 240
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9069
Practice Address - Country:US
Practice Address - Phone:678-565-1806
Practice Address - Fax:678-565-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111279ASCAMedicare ID - Type UnspecifiedGROUP NUMBER