Organization
SOUTHERN ENDOSCOPY SUITE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK B. KUKLER D.O., (OWNER)
(678) 985-2000
Entity
Organization
Contact information
Practice address
763 OLD NORCROSS RD, LAWRENCEVILLE, GA 30045-4317
(678) 985-2000
(678) 985-1999
Mailing address
763 OLD NORCROSS RD, LAWRENCEVILLE, GA 30045-4317
(678) 985-2000
(678) 985-1999
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
261QE0800X
Endoscopy Clinic/Center
Primary
067-200
GA
Other
Enumeration date
05/10/2006
Last updated
11/28/2017
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