Provider Demographics
NPI:1508210378
Name:APEX MEDICAL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:APEX MEDICAL SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:762-323-1030
Mailing Address - Street 1:1075 LAFAYETTE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3507
Mailing Address - Country:US
Mailing Address - Phone:706-443-5273
Mailing Address - Fax:706-443-5275
Practice Address - Street 1:1075 LAFAYETTE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3507
Practice Address - Country:US
Practice Address - Phone:706-443-5273
Practice Address - Fax:762-323-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003210036AMedicaid