Provider Demographics
NPI:1942548870
Name:ISPM ASC AT CAMP CREEK LLC
Entity Type:Organization
Organization Name:ISPM ASC AT CAMP CREEK LLC
Other - Org Name:ALLIANCE SURGERY CENTER AT CAMP CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-920-4950
Mailing Address - Street 1:PO BOX 11407 DEPT 2330
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0001
Mailing Address - Country:US
Mailing Address - Phone:404-920-4950
Mailing Address - Fax:404-920-4959
Practice Address - Street 1:3885 PRINCETON LAKES WAY SW
Practice Address - Street 2:STE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5589
Practice Address - Country:US
Practice Address - Phone:404-920-4950
Practice Address - Fax:404-920-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical