Organization
MEDLOCK SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP F MACON M.D. (OWNER)
(770) 455-4600
Entity
Organization
Contact information
Practice address
10700 MEDLOCK BRIDGE RD STE 101, JOHNS CREEK, GA 30097-8455
(770) 455-4600
Mailing address
10700 MEDLOCK BRIDGE RD STE 101, JOHNS CREEK, GA 30097-8455
(770) 455-4600
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
11414
GA
Other
Enumeration date
09/29/2010
Last updated
09/29/2010
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