| Southern Cross Surgery Center, LLC | |
|
1301 Sigman Rd Ne Suite 120 Conyers GA 30012-3812 | |
| (770) 760-9360 | |
| Not Available |
| Full Name | Southern Cross Surgery Center, LLC |
|---|---|
| Speciality | Clinic/center - Ambulatory Surgical |
| Location | 1301 Sigman Rd Ne, Conyers, Georgia |
| Authorized Official Name and Position | R. L. Talley (MD/OWNER) |
| Authorized Official Contact | 7707609360 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Cross Surgery Center, LLC 1301 Sigman Rd Ne Suite 120 Conyers GA 30012-3812 Ph: (770) 760-9360 | Southern Cross Surgery Center, LLC 1301 Sigman Rd Ne Suite 120 Conyers GA 30012-3812 Ph: (770) 760-9360 |
| NPI Number | 1225321508 |
|---|---|
| Provider Enumeration Date | 05/19/2011 |
| Last Update Date | 04/29/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225321508 | NPI | - | NPPES |
| 202G490818 | Other | GA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 29957 (Georgia) | Secondary |
| 261QA1903X | Clinic/center - Ambulatory Surgical | 029957 (Georgia) | Primary |
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