Provider Demographics
NPI:1881850121
Name:NORTHEAST GEORGIA UROLOGICAL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA UROLOGICAL SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-535-0000
Mailing Address - Street 1:660 LANIER PARK DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2075
Mailing Address - Country:US
Mailing Address - Phone:770-535-0000
Mailing Address - Fax:770-532-3911
Practice Address - Street 1:660 LANIER PARK DR
Practice Address - Street 2:SUITE H
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2075
Practice Address - Country:US
Practice Address - Phone:770-535-0000
Practice Address - Fax:770-532-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical