Organization
WGUASC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLINT HOFFMAN (SR VP)
(770) 838-8302
Entity
Organization
Contact information
Practice address
150 CLINIC AVE STE 203, CARROLLTON, GA 30117-4402
(707) 834-6988
(770) 834-1090
Mailing address
100 GREENWAY BLVD FL 2, CARROLLTON, GA 30117-4338
(770) 838-8710
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
05/09/2018
Last updated
02/29/2024
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