Provider Demographics
NPI:1700093044
Name:ASSOCIATED FOOT AND ANKLE AMBULATORY SURGERY CENTER INC
Entity Type:Organization
Organization Name:ASSOCIATED FOOT AND ANKLE AMBULATORY SURGERY CENTER INC
Other - Org Name:AFA AMBULATORY SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMAHA
Authorized Official - Suffix:II
Authorized Official - Credentials:DPM
Authorized Official - Phone:478-745-2600
Mailing Address - Street 1:1854 FORSYTH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1169
Mailing Address - Country:US
Mailing Address - Phone:478-745-2600
Mailing Address - Fax:478-742-5657
Practice Address - Street 1:1854 FORSYTH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1169
Practice Address - Country:US
Practice Address - Phone:478-745-2600
Practice Address - Fax:478-742-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-175261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical