Organization
NORTHWEST GEORGIA ORTHOPAEDIC SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLIN LEMAISTRE (OFFICER / AUTHORIZED OFFICIAL)
(713) 343-0832
Entity
Organization
Contact information
Practice address
2550 WINDY HILL RD SE, STE 218, MARIETTA, GA 30067-8665
(770) 953-8058
(770) 951-0096
Mailing address
2550 WINDY HILL RD SE, STE 218, MARIETTA, GA 30067-8665
(770) 953-8058
(770) 951-0096
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
033-108
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00724028A
—
GA
01
—
3309
BLUE CROSS
GA
01
—
490003330
RR MEDICARE
GA
01
—
5951075
AETNA PPO
GA
01
—
68-00052
UNITED HEALTHCARE
GA
01
—
853971
AETNA H/POS
GA
Enumeration date
08/12/2005
Last updated
10/14/2024
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