Organization
SOUTHLAKE AMBULATORY SURGERY CENTER, LLLP
Active
Other names
Spivey Station Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN R MCLAIN (EXECUTIVE VP & COO)
(770) 991-8000
Entity
Organization
Contact information
Practice address
7813 SPIVEY STATION BLVD, SUITE 100, JONESBORO, GA 30236-0000
(770) 268-6000
(770) 268-6001
Mailing address
11 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2615
(770) 897-8000
(770) 268-6001
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
031127
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00973046A
—
GA
05
—
306743
—
GA
Enumeration date
08/29/2006
Last updated
07/25/2013
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