Organization
NORTHWOODS SURGERY CENTER LLC
Active
Other names
Northwoods Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL KYLE BURTNETT (SVP OF OUTPATIENT SERVICES, TENET)
(469) 893-2153
Entity
Organization
Contact information
Practice address
1230 BALD RIDGE MARINA RD, SUITE 8, CUMMING, GA 30041
(770) 888-7105
(770) 888-7107
Mailing address
1230 BALD RIDGE MARINA RD, SUITE 8, CUMMING, GA 30041
(770) 888-7105
(770) 888-7107
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
058326
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000923447A
—
GA
01
—
100852
BLUE CROSS BLUE SHIELD
GA
Enumeration date
03/15/2006
Last updated
06/16/2016
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