Provider Demographics
NPI:1063687267
Name:SOUTHERN SURGICAL ASSISTANTS, LLC
Entity Type:Organization
Organization Name:SOUTHERN SURGICAL ASSISTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:KANCLERZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, RNFA
Authorized Official - Phone:678-591-8644
Mailing Address - Street 1:PO BOX 7042
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30502-0042
Mailing Address - Country:US
Mailing Address - Phone:678-591-8344
Mailing Address - Fax:770-965-3365
Practice Address - Street 1:5742 ALLEE WAY
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517
Practice Address - Country:US
Practice Address - Phone:678-591-8344
Practice Address - Fax:770-965-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty