Provider Demographics
NPI:1548223068
Name:COLUMBIA SURGICARE OF AUGUSTA, LTD
Entity Type:Organization
Organization Name:COLUMBIA SURGICARE OF AUGUSTA, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:915 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4115
Mailing Address - Country:US
Mailing Address - Phone:706-738-4925
Mailing Address - Fax:706-738-7224
Practice Address - Street 1:915 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4115
Practice Address - Country:US
Practice Address - Phone:706-738-4925
Practice Address - Fax:706-738-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121022261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000356738AMedicaid
GA111009ASCAMedicare PIN