CPMSC CARROLLTON NPI 1316233612

NPI Information

NPI: 1316233612
Provider Name: CPMSC CARROLLTON
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 11D2022796

Address:
812 SOUTH PARK STREET
SUITE 5-B
CARROLLTON, GA
ZIP 30117
Phone: (770) 929-9033
Get Directions

CPMSC CARROLLTON is an ambulatory surgical clinic center in Carrollton, GA. CPMSC CARROLLTON NPI is 1316233612. The provider is registered as an organization entity type.

The provider's business location address is:

812 SOUTH PARK STREET
SUITE 5-B
CARROLLTON, GA
ZIP 30117
Phone: (770) 929-9033
Fax: (770) 929-9092

The provider's authorized official is Victoria Beck .
The authorized official title is Cfo and has the following contact phone number (404) 920-4950.

The CLIA number assigned to this NPI record is 11D2022796 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/24/2011 and was last updated on 10/20/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical			No
2	261QA1903X	Clinic/Center	Ambulatory Surgical		GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	202G491952	MEDICARE PIN	GEORGIA
2	003126952A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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