Provider Demographics
NPI:1245778075
Name:CUTTING EDGE SURGICAL GROUP, LLC
Entity Type:Organization
Organization Name:CUTTING EDGE SURGICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RNFA
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-317-0814
Mailing Address - Street 1:190 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MORELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30259-2813
Mailing Address - Country:US
Mailing Address - Phone:770-317-0814
Mailing Address - Fax:
Practice Address - Street 1:190 BEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:MORELAND
Practice Address - State:GA
Practice Address - Zip Code:30259-2813
Practice Address - Country:US
Practice Address - Phone:770-317-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113659163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty