SOUTHLAKE AMBULATORY SURGERY CENTER, LLLP
Ambulatory Health at Spivey Station Blvd, Jonesboro, GA

License number
Georgia 031127
Category
Ambulatory Health
Type
Ambulatory Surgical
Owner
Name: MR. JOHN R MCLAIN
Title: EXECUTIVE VP & COO
Phone: (770) 991-8000
Address
Address 2
7813 Spivey Station Blvd SUITE 100, Jonesboro, GA 30236
11 Upper Riverdale Rd SW, Riverdale, GA 30274
National Provider ID: 1508974353
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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SOUTHLAKE AMBULATORY SURGERY CENTER, L.L.L.P

7813 Spivey Sta Blvd SUITE 100, Jonesboro, GA 30236

Registration:
Sep 13, 1996
State ID:
K629420
Business type:
Domestic Limited Partnership
CEOs:
H. Diane Green (Secretary), 11 Upper Riverdale Rd, Riverdale, GA 30274 (Physical),Gina Dickson (CFO), 11 Upper Riverdale Rd, Riverdale, GA 30274 (Physical),E. James Crissey (CEO), 11 Upper Riverdale Rd, Riverdale, GA 30274 (Physical)
Agent:
David P. Winkle,201 17 St, Atlanta, GA (Physical)

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