Provider Demographics
NPI:1225421928
Name:BLUE SKY SURGICAL ASSISTANTS, LLC
Entity Type:Organization
Organization Name:BLUE SKY SURGICAL ASSISTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHAIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:GHAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-931-4915
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 880
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1731
Mailing Address - Country:US
Mailing Address - Phone:404-493-4915
Mailing Address - Fax:404-420-2536
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE 880
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-493-4915
Practice Address - Fax:404-420-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty