NORTHWEST GEORGIA ORTHOPAEDIC SURGERY CENTER LLC NPI 1598767154

NPI Information

NPI: 1598767154
Provider Name: NORTHWEST GEORGIA ORTHOPAEDIC SURGERY CENTER, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 11D0911127

Address:
2550 WINDY HILL RD SE
STE 218
MARIETTA, GA
ZIP 30067
Phone: (770) 953-8058
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NORTHWEST GEORGIA ORTHOPAEDIC SURGERY CENTER, LLC is an ambulatory surgical clinic center in Marietta, GA. NORTHWEST GEORGIA ORTHOPAEDIC SURGERY CENTER, LLC NPI is 1598767154. The provider is registered as an organization entity type.

The provider's business location address is:

2550 WINDY HILL RD SE
STE 218
MARIETTA, GA
ZIP 30067-665
Phone: (770) 953-8058
Fax: (770) 951-0096

The provider's authorized official is Jenetha D Moran .
The authorized official title is Officer / Authorized Official and has the following contact phone number (972) 763-3893.

The CLIA number assigned to this NPI record is 11D0911127 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/12/2005 and was last updated on 11/7/2018.

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	033-108	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	490003330	OTHER	GEORGIA	RR MEDICARE
2	68-00052	OTHER	GEORGIA	UNITED HEALTHCARE
3	853971	OTHER	GEORGIA	AETNA H/POS
4	00724028A	MEDICAID	GEORGIA
5	3309	OTHER	GEORGIA	BLUE CROSS
6	5951075	OTHER	GEORGIA	AETNA PPO

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: 4/28/2024

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