Provider Demographics
NPI:1285806620
Name:ATLANTA SURGICENTER FOR WOMENS CHOICE
Entity type:Organization
Organization Name:ATLANTA SURGICENTER FOR WOMENS CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-534-0035
Mailing Address - Street 1:PO BOX 33296
Mailing Address - Street 2:
Mailing Address - City:DECATUN
Mailing Address - State:GA
Mailing Address - Zip Code:30033-0296
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1874 PIEDMONT ROAD
Practice Address - Street 2:SUITE 570E
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324
Practice Address - Country:US
Practice Address - Phone:404-347-9191
Practice Address - Fax:404-745-9041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTA SURGICENTER FOR WOMENS CHOICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023086207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty