Organization
MOULTRIE UROLOGY ASC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAHA KASSIS BADDOUR RMM (OFFICE MANAGER)
(229) 985-3066
Entity
Organization
Contact information
Practice address
2 HOSPITAL PARK, MOULTRIE, GA 31768-6700
(229) 985-3066
(229) 890-2092
Mailing address
2 HOSPITAL PARK, MOULTRIE, GA 31768-6700
(229) 985-3066
(229) 890-2092
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
035-219
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00919619A
—
GA
Enumeration date
06/07/2007
Last updated
01/08/2010
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