Organization
STATESBORO AMBULATORY SURGERY CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT W CUSHNER D.P.M. (CEO/OWNER)
(912) 489-8727
Entity
Organization
Contact information
Practice address
95 BEL AIR DRIVE, STATESBORO, GA 30461
(912) 489-6519
(912) 764-7882
Mailing address
95 BEL AIR DR, STATESBORO, GA 30461-6879
(912) 489-6519
(912) 764-7882
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000624896A
—
GA
01
—
GRP4317
PROVIDER TRANSACTION ACCESS NUMBER
—
Enumeration date
12/01/2011
Last updated
12/01/2011
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