Organization
ISPM ASC AT COVINGTON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA BECK (CFO)
(404) 920-4950
Entity
Organization
Contact information
Practice address
5303 ADAMS STREET, SUITE C, COVINGTON, GA 30014
(770) 929-9033
(770) 929-9092
Mailing address
PO BOX 11407, DEPT 2338, BIRMINGHAM, AL 35246-2338
(404) 920-4950
(404) 920-4959
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
GA
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003127119A
—
GA
Enumeration date
07/02/2009
Last updated
11/10/2022
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