Organization
SOUTH GEORGIA SURGERY CENTER, LLC
Active
Other names
South Georgia Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J LUPI DO (OWNER)
(912) 267-9000
Entity
Organization
Contact information
Practice address
306 ISABELLA STREET, WAYCROSS, GA 31501-3636
(912) 490-7246
(912) 490-7247
Mailing address
306 ISABELLA STREET, WAYCROSS, GA 31501-3636
(912) 267-9000
(912) 267-9028
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
111252ASCA
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
495658553A
—
GA
01
—
P00188566
RR MEDICARE
GA
Enumeration date
08/31/2006
Last updated
04/08/2010
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