Provider Demographics
NPI:1336458280
Name:ATLANTA SURGICAL ASSISTANCE
Entity Type:Organization
Organization Name:ATLANTA SURGICAL ASSISTANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORTCH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:404-797-2497
Mailing Address - Street 1:3466 MARK HALL DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5342
Mailing Address - Country:US
Mailing Address - Phone:770-565-1276
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:105 COLLIER RD NW STE 1080
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1753
Practice Address - Country:US
Practice Address - Phone:404-352-2850
Practice Address - Fax:888-329-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN130308NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty