Provider Demographics
NPI:1427083047
Name:SOUTHEASTERN PAIN AMBULATORY SURGERY CENTER
Entity type:Organization
Organization Name:SOUTHEASTERN PAIN AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-558-8501
Mailing Address - Street 1:1140 HAMMOND DRIVE
Mailing Address - Street 2:D 4140
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5331
Mailing Address - Country:US
Mailing Address - Phone:770-558-8501
Mailing Address - Fax:770-558-8512
Practice Address - Street 1:1140 HAMMOND DRIVE
Practice Address - Street 2:D 4140
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-558-8501
Practice Address - Fax:770-558-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical