Organization
EAST COBB PODIATRY SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK R LIGHT D.P.M. (PHYSICIAN)
(770) 977-8221
Entity
Organization
Contact information
Practice address
4439 ROSWELL RD, MARIETTA, GA 30062-6452
(770) 977-8221
(770) 977-8222
Mailing address
4439 ROSWELL RD, MARIETTA, GA 30062-6452
(770) 977-8221
(770) 977-8222
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
11C0001132
GA
Other
Enumeration date
09/13/2007
Last updated
06/28/2012
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