Organization
CPMSC CARROLLTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA BECK (CFO)
(404) 920-4950
Entity
Organization
Contact information
Practice address
812 SOUTH PARK STREET, SUITE 5-B, CARROLLTON, GA 30117
(770) 929-9033
(770) 929-9092
Mailing address
P.O. BOX 11407, DEPT 3185, BIRMINGHAM, AL 35426-3185
(770) 929-9033
(770) 929-9092
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
GA
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003126952A
—
GA
Enumeration date
06/24/2011
Last updated
10/20/2015
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