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Organization

COOSA PROCEDURE CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DAWNETTA JANENE HOLLADAY M.D. (CEO)
(706) 549-8114
Entity
Organization

Contact information

Practice address
18 RIVERBEND DR SW STE 120, ROME, GA 30161-6019
(706) 378-1202
(706) 378-1204
Mailing address
PO BOX 80883, ATHENS, GA 30608-0883
(706) 549-8114
(706) 549-7558

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
057288
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
196957398A
GA
Enumeration date
10/03/2006
Last updated
01/08/2018
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