Organization
LAKE SPIVEY AMBULATORY SURGERY CARE, LLC
Active
Other names
Spivey Station Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL)
(909) 235-4307
Entity
Organization
Contact information
Practice address
7813 SPIVEY STATION BLVD, SUITE 100, JONESBORO, GA 30236-2900
(770) 268-6000
Mailing address
11 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2615
(770) 991-8000
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
031127
GA
Other
Enumeration date
02/04/2016
Last updated
02/04/2016
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