Provider Demographics
NPI:1568984375
Name:AMERICAN ACCESS CARE OF ATLANTA ASC LLC
Entity Type:Organization
Organization Name:AMERICAN ACCESS CARE OF ATLANTA ASC LLC
Other - Org Name:AZURA SURGERY CENTER ATLANTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-369-1444
Mailing Address - Street 1:PO BOX 419861
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9861
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:
Practice Address - Street 1:250 E PONCE DELEON AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3406
Practice Address - Country:US
Practice Address - Phone:404-377-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003205661AMedicaid