Provider Demographics
NPI:1861109464
Name:BRASELTON ASC, LLC
Entity type:Organization
Organization Name:BRASELTON ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-219-1703
Mailing Address - Street 1:PO BOX 748877
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8877
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1524 RIVER PLACE
Practice Address - Street 2:SUITE 100
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5614
Practice Address - Country:US
Practice Address - Phone:770-848-1730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical