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Organization

NEWTON ROCKDALE AMBULATORY SURGERY CENTER

Active
Other names
Pulliam Ambulatory Surgery Center
Organization subpart
No

Provider details

NPI number
Authorized official
MORRIS MICHAEL PULLIAM M.D. (MEDICAL DIRECTOR)
(770) 786-1234
Entity
Organization

Contact information

Practice address
4167 HOSPITAL DR NE, COVINGTON, GA 30014-2565
(770) 786-1234
(770) 385-0813
Mailing address
PO BOX 469, COVINGTON, GA 30015-0469
(770) 786-1234
(770) 385-0813

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
122-036
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000420802A
GA
01
490002755
RRR MEDICARE #
GA
01
51001066001
BLUE CROSS BLUE SHIELD
GA
Enumeration date
10/26/2005
Last updated
10/10/2011
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