Exhibit
      10.55

    


    FIRST
      Amendment to Credit Agreement and CONSENT To ACQUISITION


    


    FIRST
      AMENDMENT TO CREDIT AGREEMENT AND CONSENT TO ACQUISITION (this "Agreement"),
      dated
      as of May 31, 2007, among NOVAMED, INC., a Delaware corporation (“Borrower”),
      NATIONAL CITY BANK (“Agent”)
      and
      the Lenders signatory hereto. Terms not defined herein have the meanings given
      to them in the Credit Agreement (as hereinafter defined). 

     

    BACKGROUND

     

    A.    Borrower,
      the Lenders signatory thereto and Agent are party to that certain Sixth Amended
      and Restated Credit Agreement dated as of February 7, 2007 (the "Credit
      Agreement").

     

    B.    Borrower
      has requested that Agent and Lenders amend the Credit Agreement and consent
      to
      the acquisition by Borrower or a Wholly-Owned Subsidiary of Borrower of a 62.5%
      interest in Surgery Center of Kalamazoo, L.L.C. for a purchase price of
      $24,600,000 (the “Kalamazoo
      Acquisition”)
      which
      acquisition requires the consent of the Required Lenders.

     

    C.    Agent
      and
      Lenders are willing to enter into this Agreement to consent to the Kalamazoo
      Acquisition and amend the Credit Agreement upon the terms and conditions set
      forth below.  

     

    NOW
      THEREFORE, in consideration of the matters set forth in the recitals and the
      covenants and provisions herein set forth, and other valuable consideration,
      the
      receipt and sufficiency of which are hereby acknowledged, the parties hereto
      agree as follows:

     

    1.    Consent.
      Borrower
      hereby represents and warrants that after giving effect to the Kalamazoo
      Acquisition on a pro forma basis it will be in compliance with all financial
      covenants under the Credit Agreement as more fully detailed on the pro forma
      compliance certificate and Agreed EBITDA certificate previously disclosed to
      the
      Agent and Lenders and that the Kalamazoo Acquisition fully complies with the
      definition of Permitted Acquisition except for clause (c) of such definition
      which requires the consent of the Lenders contained herein. Based upon such
      representations and warranties, the Agent and the Lenders hereby consent to
      the
      Kalamazoo Acquisition by Borrower or a Wholly-Owned Subsidiary of Borrower
      for a
      purchase price not to exceed $24,600,000. Upon consummation of the Kalamazoo
      Acquisition such acquisition will be considered a Permitted Acquisition for
      all
      purposes under the Credit Agreement.

     

    2.    Amendments
      to Credit Agreement.
      

     

    (a)    Section
      1.1 of the Credit Agreement is hereby amended by adding the following new
      definition thereto:

     

    "Surgery
      Center of Kalamazoo"
      means
      Surgery Center of Kalamazoo, L.L.C., a Michigan limited liability
      company.

     

    (b)    Section
      1.1 of the Credit Agreement is hereby further amended by deleting the definition
      of "Total Funded Debt" therein and replacing it with the following new
      definition of "Total Funded Debt":

     

    “Total
      Funded Debt"
      of any
      Person means all Indebtedness of such Person except Indebtedness specified
      in
clause
      (g)
      of the
      definition of Indebtedness; provided,
      with
      respect to Indebtedness of NovaMed of New Albany permitted to be outstanding
      under Section
      7.2.2(q)
      hereof,
      that amount of such Indebtedness of NovaMed of New Albany guaranteed by a Person
      or Persons other than a Credit Party, ASC Subsidiary, Minority ASC Entity or
      Affiliate of a Credit Party, ASC Subsidiary or Minority ASC Entity shall be
      excluded for purposes of calculating this definition and provided,
      further,
      the
      amount of outstanding Indebtedness of Surgery Center of Kalamazoo included
      in
      the calculation of this definition shall equal the principal amount of such
      Indebtedness multiplied by that percentage of the outstanding equity of Surgery
      Center of Kalamazoo owned by the Borrower or any Wholly-Owned
      Subsidiary.

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

       

    

    (c)    Section
      7.2.2 of the Credit Agreement is hereby amended by adding the following new
      clauses (s) and (t) thereto:

     

    "(s)
      Indebtedness of Surgery Center of Kalamazoo in an amount not to exceed
      $2,000,000; and

     

    (t)
      Indebtedness of Borrower consisting of a guarantee of the Indebtedness of
      Surgery Center of Kalamazoo permitted under clause
      (s)
      of this
Section
      7.2.2.
      provided
      that such guarantee is limited to a pro rata portion of such Indebtedness equal
      to Borrower’s owned pro rata portion of the outstanding equity interests of
      Surgery Center of Kalamazoo."   

     

    (d)    Section
      7.2.3 of the Credit Agreement is hereby amended by deleting clause (m) thereof
      and replacing it with the following new clause (m):

     

    "(m) Liens
      on
      the assets of NovaMed of New Albany and Surgery Center of Kalamazoo securing
      the
      Indebtedness permitted by clause
      (q)
      and
clause
      (s)
      of
Section
      7.2.2.,
      respectively."

     

    3.    Representations
      and Warranties.
      To
      induce Agent and Lenders to enter into this Agreement, Borrower represents
      and
      warrants to Agent and the Lenders that the execution, delivery and performance
      by Borrower of this Agreement is within its corporate powers, as applicable,
      has
      been duly authorized by all necessary corporate action and does not and will
      not
      violate or conflict with any provision of law applicable to Borrower, the
      Certificate of Incorporation or Bylaws or other organizational document of
      Borrower, or any order, judgment or decree of any court or other agency of
      government or any contractual obligation binding upon Borrower; and the Credit
      Agreement as amended as of the date hereof is the legal, valid and binding
      obligation of Borrower enforceable against Borrower in accordance with its
      terms
      except as may be limited by bankruptcy, insolvency, reorganization, moratorium
      or other laws affecting creditors' rights generally and the effects of general
      principles of equity. Borrower hereby further represents and warrants that,
      as
      of the Effective Date, the Borrower and its Subsidiaries are Solvent on a
      consolidated basis and the Borrower acknowledges that its warranties and
      representations contained in the Credit Agreement and the other Loan Documents,
      are true and correct in all material respects both before and after the
      Effective Date (both before and after giving effect to the transactions
      contemplated hereby) with the same effect as though made on such date (except
      to
      the extent stated to relate to an earlier date, in which case such
      representations and warranties were true and correct in all material respects
      as
      of such earlier date).

     

    4.    Conditions.
      The
      effectiveness of the consent and amendments stated in this Agreement is subject
      to each of the following conditions precedent (the date of consummation of
      which
      shall be the "Effective
      Date"):

     

    (A)    Agreement.
      Agent
      shall have received counterparts of this Agreement duly executed by Borrower,
      Agent and the Required Lenders.

     

    
      
        
        

      

      
        2

        
          

        

      

      
        
        

      

    

     

    (B)    No
      Default.
      After
      giving effect to this Agreement, and the waivers contained herein no Default
      or
      Event of Default under the Credit Agreement shall have occurred and be
      continuing.

     

    (C)    Warranties
      and Representations.
      The
      warranties and representations of the Loan Parties contained in this Agreement,
      the Credit Agreement and the other Loan Documents, shall each be true and
      correct in all material respects as of the effective date hereof, with the
      same
      effect as though made on such date (except to the extent stated to relate to
      an
      earlier date, in which case such representations and warranties were true and
      correct in all material respects as of such earlier date).

     

    (D)    Payment
      of Expenses.
      Borrower shall have paid all reasonable out of pocket expenses (including
      reasonable attorney’s fees) of Agent in connection this Agreement.

     

    (E)    Additional
      Deliveries.
      Borrower and the other Loan Parties shall have executed and delivered such
      additional certificates, documents, amendments to other Loan Documents and
      financing statements as Agent may require in connection with the transactions
      contemplated by this Agreement.

     

    5.    Miscellaneous.

     

    (A)    Captions.
      Section
      captions used in this Agreement are for convenience only, and shall not affect
      the construction of this Agreement.

     

    (B)    Governing
      Law.
      This
      Agreement shall be governed by and shall be construed and enforced in accordance
      with the internal laws of the State of Illinois, without regard to conflict
      of
      laws principles.

     

    (C)    Counterparts.
      This
      Agreement may be executed in any number of counterparts, and each such
      counterpart shall be deemed to be an original, but all such counterparts shall
      together constitute but one and the same Agreement. Delivery of an executed
      signature page to this Agreement by telecopy shall be deemed to constitute
      delivery of an originally executed signature page hereto.

     

    (D)    Successors
      and Assigns.
      This
      Agreement shall be binding upon and inure to the benefit of the parties hereto
      and their respective successors and assigns.

     

    (E)    References.
      Any
      reference to the Credit Agreement contained in any notice, request, certificate,
      or other document executed concurrently with or after the execution and delivery
      of this Agreement shall be deemed to include this Agreement unless the context
      shall otherwise require.

     

    (F)    Continued
      Effectiveness.
      Notwithstanding anything contained herein, the terms of this Agreement are
      not
      intended to and do not serve to effect a novation as to the Credit Agreement.
      The parties hereto expressly do not intend to extinguish the Credit Agreement.
      Instead, it is the express intention of the parties hereto to reaffirm the
      indebtedness created under the Credit Agreement, which is evidenced by the
      Notes
      and secured by the Collateral. The Credit Agreement as amended hereby and each
      of the other Loan Documents remains in full force and effect.

     

     [Signature
      Pages Follow]

     

    
      
        
        

      

      
        3

        
          

        

      

      
        
        

      

    


    Witness
      the due execution hereof by the respective duly authorized officers of the
      undersigned as of the date first above written.

     

    
      	 	 	 
	 	NOVAMED,
              INC.
	 
 	 
 	 
 
	 	By:  	/s/ Scott
              T. Macomber
	 	Name: 	Scott T. Macomber
	 	
              Title:

            	
              Executive
                Vice President and Chief Financial Officer

            
	 	
            
	 	 


    


    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    
      	 	
              NATIONAL
                CITY BANK, 

              Individually
                as a Lender, as Letter of Credit

              Issuer
                and as Agent

              


              By
                /s/
                James M. Kershner

              Title:
                Vice President

               

              LASALLE
                BANK NATIONAL ASSOCIATION 

              Individually
                as a Lender

              


              By
                /s/ Sam L. Dendrinos

              Title:
                Senior Vice President

               

              THE
                NORTHERN TRUST COMPANY 

              Individually
                as a Lender

              


              By
                /s/
                Phillip N. McCaulay

              Title: Second
                Vice President

              


              ASSOCIATED
                BANK, N.A.

              Individually
                as a Lender

              


              By
                /s/
                Viktor Gottlieb

              Title: AVP

              


              CHARTER
                ONE BANK

              Individually
                as a Lender

              


              By
                /s/ Richard H. Ault

              Title: Vice
                President

              


              JPMORGAN
                CHASE BANK, NATIONAL ASSOCIATION

              Individually
                as a Lender

              


              By
                /s/ Dianne Stark

              Title: Senior
                Banker

              


              BMO
                CAPITAL MARKETS FINANCING, INC.

              Individually
                as a Lender

              


              By
                /s/ Michael D. Pincus

              Title: Managing
                Director