Basic Information
| Provider Information | |||||||||
| NPI: | 1649486796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHSIDE DUNWOODY OUTPATIENT SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4553 N SHALLOWFORD RD | ||||||||
| Address2: | SUITE 60C | ||||||||
| City: | DUNWOODY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303386408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704576303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4553 N SHALLOWFORD RD | ||||||||
| Address2: | SUITE 60C | ||||||||
| City: | DUNWOODY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303386408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704576303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 05/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | SILVER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7704576303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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.