Basic Information
| Provider Information | |||||||||
| NPI: | 1568884104 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EMORY AMBULATORY SURGERY CENTER AT DUNWOODY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1365 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047785000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4555 N SHALLOWFORD RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303386407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047784000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2014 | ||||||||
| LastUpdateDate: | 04/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | BRUNN | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4047785000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.