| Organization Name: | WESTSIDE SURGERY LLC |
| NPI Number: | 1013253178 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMBER PATTERSON (PRACTICE ADMINISTRATOR) |
| Mailing Address: | 314 Westside Dr Douglas |
| State: | GA US |
| Postal Code: | 315333530 |
| Phone Number: | 9123842200 |
| Fax Number: | |
| NPI Enumeration Date: | 12/18/2012 |
| NPI Last Update Date: | 12/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 034-403 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |