Organization
NORTHEAST GEORGIA PROCEDURE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAWNETTA JANENE HOLLADAY M.D. (CEO)
(706) 549-8114
Entity
Organization
Contact information
Practice address
1620 PRINCE AVE, SUITE B, ATHENS, GA 30606-6008
(706) 549-8114
(706) 549-0151
Mailing address
P O BOX 80307, ATHENS, GA 30608-0307
(706) 549-8114
(706) 549-0151
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
029-303
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
938358734A
—
GA
Enumeration date
10/03/2006
Last updated
02/11/2013
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