| Organization Name: | ORTHOATLANTA SURGERY CENTER OF AUSTELL, LLC |
| NPI Number: | 1053632372 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LINDA TERHARK (ADMINISTRATOR) |
| Mailing Address: | 3672 Marathon Circle Suite 120 Austell |
| State: | GA US |
| Postal Code: | 301066821 |
| Phone Number: | 6789458551 |
| Fax Number: | 6789458549 |
| NPI Enumeration Date: | 06/21/2010 |
| NPI Last Update Date: | 03/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |