Provider Demographics
NPI:1750629325
Name:PREMIER AMBULATORY SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:PREMIER AMBULATORY SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPELLMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:678-872-8750
Mailing Address - Street 1:211 CHICOPEE DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1269
Mailing Address - Country:US
Mailing Address - Phone:678-872-8750
Mailing Address - Fax:678-872-8769
Practice Address - Street 1:211 CHICOPEE DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1269
Practice Address - Country:US
Practice Address - Phone:678-872-8750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23819261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical