NPIMap

Organization Active NPI

Newton Rockdale Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Covington, GA
National Provider Identifier
1396735833
Registry record updated Oct 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
122-036 Issued in GA
Legal business name
NEWTON ROCKDALE AMBULATORY SURGERY CENTER
Practice address
4167 Hospital Dr NE
Covington, GA 30014-2565
Phone
(770) 786-1234
Fax
(770) 385-0813
NPI assigned
Oct 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Morris Michael Pulliam, M.D.
Title
Medical Director
Phone
(770) 786-1234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 122-036 GA Primary

Addresses

Primary practice location

4167 Hospital Dr NE
Covington, GA 30014-2565

Mailing address

PO Box 469
Covington, GA 30015-0469
Phone (770) 786-1234

Other identifiers 3

IdentifierTypeStateIssuer
000420802AMedicaidGA
490002755OtherGARRR MEDICARE #
51001066001OtherGABLUE CROSS BLUE SHIELD

Other names 1

  • Pulliam Ambulatory Surgery Center Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318204800000",
    "number": "1396735833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 469",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300150469",
            "telephone_number": "770-786-1234",
            "fax_number": "770-385-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4167 HOSPITAL DR NE",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300142565",
            "telephone_number": "770-786-1234",
            "fax_number": "770-385-0813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWTON ROCKDALE AMBULATORY SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2011-10-10",
        "status": "A",
        "authorized_official_last_name": "PULLIAM",
        "authorized_official_first_name": "MORRIS",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-786-1234",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "122-036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000420802A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRR MEDICARE #",
            "identifier": "490002755",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51001066001",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pulliam Ambulatory Surgery Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Covington, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.