Provider Demographics
NPI:1033377734
Name:SUPERIOR SURGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:SUPERIOR SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:O-MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-303-7703
Mailing Address - Street 1:PO BOX 420827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-0827
Mailing Address - Country:US
Mailing Address - Phone:404-303-7703
Mailing Address - Fax:404-303-7706
Practice Address - Street 1:5881 GLENRIDGE DR NE
Practice Address - Street 2:STE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5574
Practice Address - Country:US
Practice Address - Phone:404-303-7703
Practice Address - Fax:404-303-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN146008211D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, PodiatricGroup - Multi-Specialty