Provider Demographics
NPI:1245295823
Name:ATLANTA SURGERY CENTER, LTD
Entity type:Organization
Organization Name:ATLANTA SURGERY CENTER, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-344-5507
Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1705
Mailing Address - Country:US
Mailing Address - Phone:404-847-0893
Mailing Address - Fax:404-843-8664
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1705
Practice Address - Country:US
Practice Address - Phone:404-847-0893
Practice Address - Fax:404-843-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060169261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000374162AMedicaid
GA000374162AMedicaid