Organization
LAKESHORE TUBAL REVERSAL CENTER
Active
Other names
Lakeshore Surgical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CECILIA ASHLEIGH BATES (OFFICE MANAGER)
(770) 531-1181
Entity
Organization
Contact information
Practice address
2320 LIMESTONE PARKWAY, GAINESVILLE, GA 30501
(877) 588-5594
(770) 531-0053
Mailing address
2320 LIMESTONE PARKWAY, GAINESVILLE, GA 30501
(877) 588-5594
(770) 531-0053
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
DEA AG5691452
GA
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
GA LIC 022231
GA
Other
Enumeration date
11/17/2006
Last updated
03/10/2009
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