Organization
LOCUST GROVE ENDO CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARUNA R PRAKASH B.SC (ADMINISTRATOR)
(770) 692-0100
Entity
Organization
Contact information
Practice address
4865 BILL GARDNER PARKWAY, LOCUST GROVE, GA 30248
(770) 692-0100
Mailing address
4865 BILL GARDNER PARKWAY, LOCUST GROVE, GA 30248
(770) 692-0100
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
03/22/2007
Last updated
08/22/2020
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