Provider Demographics
NPI:1821397654
Name:RENUE SURGERY CENTER OF WAYCROSS, LLC
Entity Type:Organization
Organization Name:RENUE SURGERY CENTER OF WAYCROSS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-280-9977
Mailing Address - Street 1:PO BOX 2198
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-2198
Mailing Address - Country:US
Mailing Address - Phone:912-280-9977
Mailing Address - Fax:912-280-9995
Practice Address - Street 1:1905 TEBEAU ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6356
Practice Address - Country:US
Practice Address - Phone:912-280-9977
Practice Address - Fax:912-280-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical