Organization
LAWRENCEVILLE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLIN LEMAISTRE (AUTHORIZED OFFICIAL)
(214) 213-0732
Entity
Organization
Contact information
Practice address
758 OLD NORCROSS RD, SUITE 125, LAWRENCEVILLE, GA 30046-3385
(678) 987-0820
(678) 987-0821
Mailing address
758 OLD NORCROSS RD STE 125, LAWRENCEVILLE, GA 30046-3387
(678) 987-0820
(678) 987-0821
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
067221
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000923414A
—
GA
01
—
2633327
AETNA
GA
01
—
68-00058
UNITED HEALTHCARE
GA
01
—
7813306
AETNA US HEALTHCARE
GA
01
—
913003
BLUE CROSS BLUE SHIELD
GA
Enumeration date
05/24/2006
Last updated
10/11/2024
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