Provider Demographics
NPI:1952319378
Name:SURGICAL CENTERS OF GA PC
Entity Type:Organization
Organization Name:SURGICAL CENTERS OF GA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VITO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:478-475-9250
Mailing Address - Street 1:3556 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2509
Mailing Address - Country:US
Mailing Address - Phone:478-475-9250
Mailing Address - Fax:478-475-9315
Practice Address - Street 1:3556 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2509
Practice Address - Country:US
Practice Address - Phone:478-475-9250
Practice Address - Fax:478-475-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011177261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA436300OtherBLUE CROSS BLUE SHIELD
GA111168ASCAMedicare ID - Type Unspecified