Basic Information
| Provider Information | |||||||||
| NPI: | 1225458755 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AOS SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 INTERSTATE PKWY | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639797 | ||||||||
| FaxNumber: | 7068607686 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 J DEWEY GRAY CIR | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309091867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639797 | ||||||||
| FaxNumber: | 7068607686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2014 | ||||||||
| LastUpdateDate: | 04/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | DUFFIN | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7068639797 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.