Organization
MACON OUTPATIENT SURGERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGIA LEE (CHIEF OPERATING OFFICER)
(478) 745-4206
Entity
Organization
Contact information
Practice address
3708 NORTHSIDE DR, MACON, GA 31210-2404
(478) 745-4206
(478) 254-5463
Mailing address
3708 NORTHSIDE DR, MACON, GA 31210-2404
(478) 745-4206
(478) 254-5463
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00821697A
—
GA
Enumeration date
08/18/2008
Last updated
01/03/2012
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