Provider Demographics
NPI:1841733326
Name:AU SURGERY CENTER, LLC
Entity type:Organization
Organization Name:AU SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN OF BUSINESS FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-721-2103
Mailing Address - Street 1:1430 JOHN WESLEY GILBERT DR GC-1012
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0001
Mailing Address - Country:US
Mailing Address - Phone:706-721-7913
Mailing Address - Fax:706-721-6778
Practice Address - Street 1:1430 JOHN WESLEY GILBERT DR GC-1055
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0001
Practice Address - Country:US
Practice Address - Phone:706-721-9744
Practice Address - Fax:706-721-3511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AU DENTAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-01
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical