Basic Information
| Provider Information | |||||||||
| NPI: | 1467833160 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUSTELL SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 MULKEY RD | ||||||||
| Address2: | |||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301061186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784262188 | ||||||||
| FaxNumber: | 7708748950 | ||||||||
| Practice Location | |||||||||
| Address1: | 1610 MULKEY RD | ||||||||
| Address2: | |||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301061186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705440444 | ||||||||
| FaxNumber: | 6782390994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2015 | ||||||||
| LastUpdateDate: | 04/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | HELFMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6784262171 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 04/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | GA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.