NPIMap

Organization Active NPI

Southlake Ambulatory Surgery Center, LLLP

  • Ambulatory Surgical Clinic/Center
  • Jonesboro, GA
National Provider Identifier
1508974353
Registry record updated Jul 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
031127 Issued in GA
Legal business name
SOUTHLAKE AMBULATORY SURGERY CENTER, LLLP
Practice address
7813 Spivey Station Blvd
Suite 100
Jonesboro, GA 30236-0000
Phone
(770) 268-6000
Fax
(770) 268-6001
NPI assigned
Aug 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2013

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

Authorized official

Name
Mr. John R McLain
Title
Executive VP & Coo
Phone
(770) 991-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 031127 GA Primary

Addresses

Primary practice location

7813 Spivey Station Blvd
Suite 100
Jonesboro, GA 30236-0000

Mailing address

11 Upper Riverdale Rd SW
Riverdale, GA 30274-2615
Phone (770) 897-8000

Other identifiers 2

IdentifierTypeStateIssuer
00973046AMedicaidGA
306743MedicaidGA

Other names 1

  • Spivey Station Surgery Center Doing business as

National Provider Directory

National Provider Directory

Locations

7823 Spivey Station Blvd
Ste 100
Jonesboro, GA 30236
Phone (404) 251-2230

7813 Spivey Station Blvd
Ste 220
Jonesboro, GA 30236
Phone (404) 778-3357

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": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374710400000",
    "number": "1508974353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 UPPER RIVERDALE RD SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742615",
            "telephone_number": "770-897-8000",
            "fax_number": "770-268-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7813 SPIVEY STATION BLVD",
            "address_2": "SUITE 100",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302360000",
            "telephone_number": "770-268-6000",
            "fax_number": "770-268-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE AMBULATORY SURGERY CENTER, LLLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2013-07-25",
        "status": "A",
        "authorized_official_last_name": "MCLAIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE VP & COO",
        "authorized_official_telephone_number": "770-991-8000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "031127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00973046A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "306743",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spivey Station Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2013; 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.