Organization
SURGICAL CENTERS OF GA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE VITO DPM (MEDICAL DIRECTOR)
(478) 475-9250
Entity
Organization
Contact information
Practice address
3556 RIVERSIDE DR, MACON, GA 31210-2509
(478) 475-9250
(478) 475-9315
Mailing address
3556 RIVERSIDE DR, MACON, GA 31210-2509
(478) 475-9250
(478) 475-9315
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
011177
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
436300
BLUE CROSS BLUE SHIELD
GA
Enumeration date
08/03/2006
Last updated
08/22/2020
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