Organization
GEORGIA UROLOGY AMBULATORY SURGICAL CENTER LLC
Active
Parent organization
GEORGIA UROLOGY, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA UROLOGY, PA
Authorized official
DR. MARK A HABER MD (MANAGING PARTNER)
(678) 284-4049
Entity
Organization
Contact information
Practice address
2685 MILSCOTT DR, DECATUR, GA 30033-5906
(404) 292-3727
(404) 294-9674
Mailing address
1930 BRANNAN RD, MCDONOUGH, GA 30253-4310
(678) 284-4040
(678) 284-4076
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D1025964
CLIA
GA
Enumeration date
07/22/2006
Last updated
01/20/2015
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