Provider Demographics
NPI:1538495742
Name:WINDWARD SURGERY CENTER
Entity Type:Organization
Organization Name:WINDWARD SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUADERRAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-844-3242
Mailing Address - Street 1:PO BOX 420709
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-0709
Mailing Address - Country:US
Mailing Address - Phone:770-844-3242
Mailing Address - Fax:678-325-2919
Practice Address - Street 1:12425 MORRIS ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4125
Practice Address - Country:US
Practice Address - Phone:770-844-3242
Practice Address - Fax:678-325-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031835261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty