NPI 1063721785

Medlock Surgical Center LLC

Organisation Exclusive Provider Organization Johns Creek, GA

Practice location

Address: 10700 Medlock Bridge Rd STE 101, Johns Creek, GA 30097-8455
Phone: (770) 455-4600

Authorised official

Name: Philip F Macon
Title: Owner
Phone: (770) 455-4600

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 11414 (GA)

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Registry record

NPI: 1063721785
Entity type: Organization
NPI issued: 29 Sep 2010
Record last updated: 29 Sep 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.