Locust Grove Endo Center
NPI #1023134640 in Locust Grove, Georgia
Provider Information
- NPI Number
- 1023134640
- Entity Type
- Organization
- Organization Name
- Locust Grove Endo Center
- Primary Specialty
- Clinic/Center - Ambulatory Surgical
- Enumeration Date
- Mar 22, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 4865 BILL GARDNER PARKWAY
- City
- Locust Grove
- State
- Georgia
- ZIP Code
- 30248
- Phone
- (770) 692-0100
Authorized Official
- Name
- ARUNA R PRAKASH, B.SC
- Title
- ADMINISTRATOR
- Phone
- (770) 692-0100
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Ambulatory Surgical — Ambulatory Surgical |
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